Modified intratympanic steroid therapy for sudden sensorineural hearing loss via tympanic tube and gelfoam as a salvage treatment

Background: Sudden sensorineural hearing loss(SSNHL) is a prevalent emergency in ear, nose, and throat practice. Previous studies have demonstrated that intratympanic steroid therapy(IST) can serve as a salvage treatment for SSNHL after the failure of systemic steroid therapy(SST).Objective: This study aimed to analyze the efficacy of modified IST involving the insertion of a tympanic tube and gelfoam as a salvage treatment for patients with SSNHL, and to explore its associated factors.Methods: Totally, 74 patients who were aged 22–81 years with SSNHL were enrolled and allocated to either the control group(n = 25) or the treatment group(n = 49) based on their treatment modalities. All patients received SST lasting for at least 7 days. Subsequently, patients in the treatment group, after SST failure, underwent IST twice a week for 2–6 weeks, while the control group did not. Efficacy was assessed by the improvement in pure tone average at the affected frequency at the beginning and end of IST.Results: Hearing improvement in all patients after IST in the treatment group was 9.71 ± 14.84 dB, with significant improvement at affected frequencies(250-8000 Hz) compared with the control group(P < 0.05). The findings indicated the duration from the onset of SSNHL to the beginning of IST as an independent factor for pure tone average improvement after treatment(P = 0.002), whereas age, duration of SST, and time of IST were not(P > 0.05).Conclusion: The modified IST was demonstrated to be a safe and effective method as a salvage treatment for SSNHL. This study explored the efficacy of a modified IST approach, incorporating the utilization of tympanic tubes and gelfoam as key components. The findings underscore the advantages of gelfoam as a strategic drug carrier placed in the round window niche. By minimizing drug loss, extending action time, and increasing perilymph concentration, gelfoam enhances the therapeutic impact of IST, contributing to improved hearing outcomes in patients with SSNHL.

Effect of psychological nursing interventions on effectiveness and quality of life in schizophrenia patients receiving modified electroconvulsive therapy

BACKGROUND Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances,hallucinations,delusions,and emotional instability.For some patients,conventional treatment methods may not effectively alleviate symptoms,necessitating the use of alternative therapeutic approaches.Modified electroconvulsive therapy(MECT)is an effective treatment modality for schizophrenia,inducing anti-depressive and antipsychotic effects through the stimulation of brain electrical activity.AIM To explore the impact of psychological nursing intervention(PNI)before and after MECT on the efficacy and quality of life of patients with schizophrenia.METHODS Eighty patients with schizophrenia who received MECT treatment from 2021 to 2023 were randomly divided into two groups:The intervention group(n=40)and the control group(n=40).The intervention group received PNI before and after MECT,while the control group received routine nursing care.The efficacy of MECT was evaluated by the Positive and Negative Syndrome Scale(PANSS)and the Clinical Global Impression Scale(CGI)before and after the treatment.The quality of life was assessed by the Short Form 36 Health Survey(SF-36)after the treatment.RESUITS The intervention group had significantly lower scores of PANSS and CGI than the control group after the treatment(P<0.05).The intervention group also had significantly higher scores of SF-36 than the control group in all domains except physical functioning(P<0.05).CONCLUSION PNI before and after MECT can improve the efficacy and quality of life of patients with schizophrenia.It is suggested that nurses should provide individualized and comprehensive psychological care for patients undergoing MECT to enhance their recovery and well-being.

Modified constraint-induced movement therapy enhances cortical plasticity in a rat model of traumatic brain injury:a resting-state functional MRI study

Modified constraint-induced movement therapy(mCIMT)has shown beneficial effects on motor function improvement after brain injury,but the exact mechanism remains unclear.In this study,amplitude of low frequency fluctuation(ALFF)metrics measured by resting-state functional magnetic resonance imaging was obtained to investigate the efficacy and mechanism of mCIMT in a control co rtical impact(CCI)rat model simulating traumatic brain injury.At 3 days after control co rtical impact model establishment,we found that the mean ALFF(mALFF)signals were decreased in the left motor cortex,somatosensory co rtex,insula cortex and the right motor co rtex,and were increased in the right corpus callosum.After 3 weeks of an 8-hour daily mClMT treatment,the mALFF values were significantly increased in the bilateral hemispheres compared with those at 3 days postoperatively.The mALFF signal valu es of left corpus callosum,left somatosensory cortex,right medial prefro ntal cortex,right motor co rtex,left postero dorsal hippocampus,left motor cortex,right corpus callosum,and right somatosensory cortex were increased in the mCIMT group compared with the control cortical impact group.Finally,we identified brain regions with significantly decreased mALFF valu es at 3 days postoperatively.Pearson correlation coefficients with the right forelimb sliding score indicated that the improvement in motor function of the affected upper limb was associated with an increase in mALFF values in these brain regions.Our findings suggest that functional co rtical plasticity changes after brain injury,and that mCIMT is an effective method to improve affected upper limb motor function by promoting bilateral hemispheric co rtical remodeling.mALFF values correlate with behavio ral changes and can potentially be used as biomarkers to assess dynamic cortical plasticity after traumatic brain injury.

Modified constraint-induced movement therapy alters synaptic plasticity of rat contralateral hippocampus following middle cerebral artery occlusion

Modified constraint-induced movement therapy is an effective treatment for neurological and motor impairments in patients with stroke by increasing the use of their affected limb and limiting the contralateral limb.However,the molecular mechanism underlying its efficacy remains unclear.In this study,a middle cerebral artery occlusion(MCAO)rat model was produced by the suture method.Rats received modified constraint-induced movement therapy 1 hour a day for 14 consecutive days,starting from the 7^th day after middle cerebral artery occlusion.Day 1 of treatment lasted for 10 minutes at 2r/min,day 2 for 20 minutes at 2 r/min,and from day 3 onward for 20 minutes at 4 r/min.CatWalk gait analysis,adhesive removal test,and Y-maze test were used to investigate motor function,sensory function as well as cognitive function in rodent animals from the 1st day before MCAO to the 21^st day after MCAO.On the 21^st day after MCAO,the neurotransmitter receptor-related genes from both contralateral and ipsilateral hippocampi were tested by micro-array and then verified by western blot assay.The glutamate related receptor was shown by transmission electron microscopy and the glutamate content was determined by high-performance liquid chromatography.The results of behavior tests showed that modified constraint-induced movement therapy promoted motor and sensory functional recovery in the middle cerebral artery-occluded rats,but had no effect on cognitive function.The modified constraint-induced movement therapy upregulated the expression of glutamate ionotropic receptor AMPA type subunit 3(Gria3)in the hippocampus and downregulated the expression of the beta3-adrenergic receptor gene Adrb3 and arginine vasopressin receptor 1 A,Avprla in the middle cerebral artery-occluded rats.In the ipsilateral hippocampus,only Adra2 a was downregulated,and there was no significant change in Gria3.Transmission electron microscopy revealed a denser distribution the more distribution of postsynaptic glutamate receptor 2/3,which is an a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor,within 240 nm of the postsynaptic density in the contralateral cornu ammonis 3 region.The size and distribution of the synaptic vesicles within 100 nm of the presynaptic active zone were unchanged.Western blot analysis showed that modified constraint-induced movement therapy also increased the expression of glutamate receptor 2/3 and brain-derived neurotrophic factor in the hippocampus of rats with middle cerebral artery occlusion,but had no effect on Synapsin I levels.Besides,we also found modified constraint-induced movement therapy effectively reduced glutamate content in the contralateral hippocampus.This study demonstrated that modified constraint-induced movement therapy is an effective rehabilitation therapy in middle cerebral artery-occluded rats,and suggests that these positive effects occur via the upregulation of the postsynaptic membrane a-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor expression.This study was approved by the Institutional Animal Care and Use Committee of Fudan University,China(approval No.201802173 S)on March 3,2018.

Preemptive analgesia with butorphanol in psychotic patients following modified electroconvulsive therapy A randomized controlled trial

BACKGROUND： Preemptive .analgesia involves introducing an analgesic prior to the onset of pain stimulation to prevent sensitizing the nervous system to subsequent stimuli that could amplify pain. OBJECTIVE： To treat psychiatric patients with intravenous （i.v.） injection of butorphanol prior to modified electroconvulsive therapy, and to observe its effect on alleviating myalgia after treatment and adverse reactions. DESIGN： A randomized controlled observation. SETTING： Renmin Hospital of Wuhan University. PARTICIPANTS： A total of 120 psychiatric patients, who accepted modified electroconvulsive therapy, were selected from the Mental Health Center of Wuhan University from June to September in 2006. All patients corresponded to the Chinese Classification and Diagnostic Criteria of Mental Disorders, and those with diseases of heart, liver, lung and kidney, glaucoma, intracranial hypertension, hyperthyreosis, and hyperkalemia were excluded. The patients were randomly divided into a control group （n = 60） and treatment group （n = 60）. In the control group, there were 42 males and 18 females, aged 17-50 years, with a mean age of （34 ± 11） years. The patients weighed 50-70 kg, with a mean body mass of （63 ± 18） kg. In the treatment group, there were 40 males and 20 females, aged 20-54 years, with a mean age of （36 ± 13） years. The patients weighed 48-72 kg, with a mean body mass of （64 ± 16） kg. Approval was obtained from the Hospital＇s Ethics Committee. Informed consents were obtained from the patients＇ relatives. A SPECTRUM5000Q multifunctional mobile electroconvulsive therapy apparatus （CORPERATION, USA） was used. METHODS： （1） Treatments： In the control group, the patients were anesthetized by i.v. injection of propofol （AstraZeneca, Italy, No.CN309） containing 0.075% efedrina, and then modified electroconvulsive therapy was performed. Circulation, respiration, and firing of brain electrical activity were continuously monitored. In the treatment group, the patients were i.v. injected with 1 mg of butorphanol tartrate parenteral solution （Jiangsu Hengrui Medicine Co., Ltd., No.05100732） 5 minutes prior to anesthesia; the remaining treatments were the same as in the control group. （2） Evaluations： myalgia conditions were assessed 6 hours after the patients opened their eyes. The patients were evaluated by a visual analogue scale and Ramsay sedation scale immediately, and at 3 minutes and 6 hours after they opened their eyes. MAIN OUTCOME MEASURES： （1） Conditions of myalgia. （2） Scores of visual analogue scale and Ramsay sedation scale. RESULTS： All 120 psychiatric patients were involved in the final analysis. （1） Conditions of myalgia： 6 hours after modified electroconvulsive therapy, 22 patients in the control group and 1 patient in the treatment group complained of myalgia, which resulted in a significant difference between the two groups （P 〈 0.05）. （2） Scores of visual analogue scale and Ramsay sedation scale： the scores of visual analogue scale at 30 minutes and 6 hours after opening eyes were significantly lower in the treatment group than the control group （P 〈 0.05）, and the scores of Ramsay sedation scale were not significantly different between the two groups （P 〉 0.05）. CONCLUSION： Preemptive analgesia by butorphanol can effectively alleviate modified electroconvulsive therapy-induced myalgia, without adverse reactions.

A Case of Refractory Insomnia Responding to Modified Electroconvulsive Therapy

A 42-year-old female patient suffered refractory insomnia. A variety of drugs including anti-anxiety, antidepressants, antipsychotics and repetitive transcranial magnetic stimulation (rTMS) have been applied in the treatment with no significant effect, whereas modified electroconvulsive therapy (MECT) can significantly improve the patient’s sleep.

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN： 1：1 paired grouping according to gender and controlled observation SETTING： Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS： Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1：1 paired principle in gender, 90 enrolled patients were assigned into treated group （n=45） and control group （n=45）. There were 39 male and 6 female in the treatment group, and they were aged （76±6）years, ranging from 71 to 84 years, and hospitalized at the 14^th to 76^th hours after onset. There were 39 male and 6 female in the control group, and they were aged （76±6）years , ranging from 70 to 82 years, and hospitalized at the 16^th to 72^th hours after onset. METHODS： Therapeutic method： Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 （including 20 mL danshen parenteral solution and 32 mg heparin） at the beginning of therapy; From the 2^nd day, compound huangqi tea bag （Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid） was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6^th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton（Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ） and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index： Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference （1995） was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5^th, 7^th and 14^th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES ： ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS： Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate： prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group： （18.4±1.9）, （41.8±2.1）, （19.7±1.7） s, Before therapy in treated group： （13.4±1.3）, （35.8±1.3）, （12.5±0.9） s, After therapy in control group： （16.9±1.5）, （39.1±1.1）, （11.9±2.1） s, P〈 0.05]：Concentration of fibrinogen （Fbg） after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group： （3.4±0.4） g/L; Before therapy in treated group： （4.3±0.7） g/L; After therapy in control group：（4.0±0.6） g/L; P 〈 0.05]. Platelet aggregation rate decreased from （37.92 ±0.85）% before therapy to （26.42±1.01）% after therapy （P 〈 0.01）. ②Change of blood lipid level： Levels of total cholesterol （TC）, triacylglycerol（TG） and low density lipoprotein cholesterol （LDL-C） of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group： （5.2±0.9）, （1.9±0.9）, （2.08±1.1） mmol/L, before therapy in treated group： （5.9±1.2）, （2.8±0.9）, （3.94±0.5） mmol/L, After therapy in control group： （6.0±1.1）, （2.6±0.8）, （3.84±0.9） mmol/L, P 〈 0.05]. ③Change of hemorheology index： Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy： （43.84±4.55）% ;After therapy： （40.48±4.02）%;P 〈 0.05]. Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [（90±1.2）, （97±2.1） cm/s,P〈 0.01]. ⑤NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group （93%,78%, P 〈 0.05）. ⑥There was no obvious adverse effect. CONCLUSION： Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.

Evaluation of serum indexes and electrophysiological characteristics after ziprasidone combined with modified electroconvulsive therapy for schizophrenian

Objective:To study the effect of ziprasidone combined with modified electroconvulsive therapy (MECT) on serum indexes and electrophysiological characteristics of schizophrenia. Methods: A total of 44 patients with schizophrenia treated in our hospital between May 2014 and July 2016 were selected and randomly divided into MECT group and control group, MECT group received ziprasidone combined with MECT therapy and control group received ziprasidone therapy. Before treatment as well as 1 month, 2 months and 3 months after treatment, serum nerve cytokine levels and inflammatory factor levels as well as nerve electrophysiology parameters were detected.Results: 1 month, 2 months and 3 months after treatment, serum BDNF, GDNF and NGF levels of both groups were significantly higher than those before treatment, IL-1β, IL-6, IL-17 and TNF-α levels were significantly lower than those before treatment, P300 and N2-P3 latency were significantly shorter than those before treatment, and P300 and N2-P3 amplitude were significantly higher than those before treatment;serum BDNF, GDNF and NGF levels of MECT group were significantly higher than those of control group, IL-1β, IL-6, IL-17 and TNF-α levels were significantly lower than those of control group, P300 and N2-P3 latency were significantly shorter than those of control group, and P300 and N2-P3 amplitude were significantly higher than those of control group.Conclusion: Ziprasidone combined with modified electroconvulsive therapy can improve neuron function, reduce neuron damage and adjust nerve electrophysiology function.

Modified moist occlusive burn therapy:a novel therapeutic approach for thermal burns

Severe thermal burns usually result in complex facial problems such as contracture and formation of hyper/hypopigmentation,contracture,hypertrophic scars or deformity,with patients often requiring reconstructive surgery.Therefore,seeking a superior and reliable burn therapy remains a great challenge for plastic and burn surgeons.However,the optimal treatment of thermal injuries remains controversial.In the 1960s,a new therapeutic concept,that sterile polyethylene film might be used as a type of moist occlusive dressing,was successively proposed.Below we present a hypothesis that combined utilization of sterile polyethylene film and burn cream may be a novel and superior therapeutic approach for thermal burns.To distinguish this method from traditional moist burn therapy,this new therapy we proposed is named modified moist occlusive burn therapy(MMOBT).

Recent advances in targeted therapy for pancreatic adenocarcinoma

Pancreatic adenocarcinoma(PDAC)is a fatal disease with a 5-year survival rate of 8%and a median survival of 6 mo.In PDAC,several mutations in the genes are involved,with Kirsten rat sarcoma oncogene(90%),cyclin-dependent kinase inhibitor 2A(90%),and tumor suppressor 53(75%–90%)being the most common.Mothers against decapentaplegic homolog 4 represents 50%.In addition,the selfpreserving cancer stem cells,dense tumor microenvironment(fibrous accounting for 90%of the tumor volume),and suppressive and relatively depleted immune niche of PDAC are also constitutive and relevant elements of PDAC.Molecular targeted therapy is widely utilized and effective in several solid tumors.In PDAC,targeted therapy has been extensively evaluated;however,survival improvement of this aggressive disease using a targeted strategy has been minimal.There is currently only one United States Food and Drug Administration-approved targeted therapy for PDAC–erlotinib,but the absolute benefit of erlotinib in combination with gemcitabine is also minimal(2 wk).In this review,we summarize current targeted therapies and clinical trials targeting dysregulated signaling pathways and components of the PDAC oncogenic process,analyze possible reasons for the lack of positive results in clinical trials,and suggest ways to improve them.We also discuss emerging trends in targeted therapies for PDAC:combining targeted inhibitors of multiple pathways.The PubMed database and National Center for Biotechnology Information clinical trial website(www.clinicaltrials.gov)were queried to identify completed and published(PubMed)and ongoing(clinicaltrials.gov)clinical trials(from 2003-2022)using the keywords pancreatic cancer and targeted therapy.The PubMed database was also queried to search for information about the pathogenesis and molecular pathways of pancreatic cancer using the keywords pancreatic cancer and molecular pathways.

异种器官移植排斥反应及其预防治疗策略

异种器官移植是解决人类器官短缺问题的潜在方案。在过去的上百年里,异种器官移植经历了早期尝试和不断进步,目前已进入新的高速发展阶段,取得了一系列的成果,但异种器官移植排斥反应的管理较同种异体器官移植排斥反应更为棘手。为此,研究者们开发出了一系列免疫抑制策略,如使用基因修饰猪供体、使用传统和新型免疫抑制药、将供体猪的胸腺与供器官一同移植等,以实现调整受体免疫系统反应,降低排斥反应强度并延长移植物存活时间。本文就异种器官移植排斥反应发生机制、预防和治疗策略的相关研究进行评述,以期为促进异种器官移植的进一步发展提供参考。

加味黄芪桂枝五物汤口服联合当归四逆汤熏洗佐治糖尿病周围神经病变临床评价

目的探讨加味黄芪桂枝五物汤口服联合当归四逆汤熏洗佐治糖尿病周围神经病变(DPN)的临床疗效。方法选取医院2022年7月至2023年11月收诊的DPN患者86例,根据治疗方法的不同分为对照组(41例)和观察组(45例)。两组患者均常规控制血糖、增强免疫及营养神经,观察组患者在此基础上加用加味黄芪桂枝五物汤口服联合当归四逆汤熏洗。两组均以14 d为1疗程,治疗3个疗程。结果观察组总有效率为93.33%,显著高于对照组的78.05%(P<0.05)。治疗后,两组患者的中医证候主症评分、次症评分及总评分均显著降低(P<0.05);多伦多临床评分系统评分均显著降低(P<0.05);腓总神经与正中神经的感觉神经传导速率和运动神经传导速率均显著加快(P<0.05);血清基质金属蛋白酶9、NOD样受体热蛋白结构域3炎性小体水平均显著降低,血清超氧化物歧化酶水平均显著升高(P<0.05);血清丙二醛水平均显著降低(P<0.05);且观察组各指标均显著优于对照组(P<0.05)。两组患者不良反应发生率相当(11.11%比7.32%,P>0.05)。结论加味黄芪桂枝五物汤口服联合当归四逆汤熏洗佐治DPN,可改善患者临床症状,提高神经传导速率,减轻炎性反应与氧化应激反应。

加味三味汤治疗帕金森病非运动症状临床疗效

目的:探讨加味三味汤治疗帕金森病患者的非运动症状方面的临床疗效,以期获得更好的治疗效果及临床经验。方法:选取符合标准的50例帕金森病患者,随机分为对照组与实验组,每组各25例,对照组予以多巴丝肼片治疗;实验组在此基础上加用加味三味汤治疗,治疗一疗程后,比较两组患者的新版世界运动障碍学会帕金森病综合量表(MDS-UPDRS)中的日常生活非运动症状与运动症状量表中的震颤、动作迟缓、认知功能、焦虑、抑郁、饮水呛咳、夜尿、失眠、嗜睡、便秘、疲惫感、口角流涎十二项指标的综合评估。结果:在治疗前,两组患者所选取指标的综合评分没有统计学意义(P>0.05);治疗后,实验组患者的综合评分相较于对照组评分减少,有统计学意义(P<0.05)。并且两组患者的评分下降率也有统计学意义(P<0.01)。结论:加味三味汤可改善帕金森病患者的非运动症状,延缓病情进展。

右单侧刺激电休克治疗对重性抑郁障碍的干预研究

目的探索右单侧刺激电休克治疗(right unilateral modified electroconvulsive therapy,RUL-MECT)对重性抑郁障碍(major depressive disorder,MDD)患者的疗效及安全性。方法采用随机双盲对照研究设计。纳入70例MDD患者,随机分为研究组、对照组,每组35例,研究组进行基于年龄法的RUL-MECT,对照组进行双侧颞叶刺激MECT,每组分别进行8次治疗。采用17项汉密尔顿抑郁量表(17-item Hamilton depression scale,HAMD-17)、成套认知功能测验(MATRICS consensus cognitive battery,MCCB)、定向力测验(orientation recovery tests,ORT)对被试抑郁症状和认知功能进行评估,记录干预过程中患者出现的不良反应。结果干预前研究组与对照组HAMD-17得分(32.89±5.68 vs.33.54±4.78)差异无统计学意义(P>0.05),经过8次干预,研究组HAMD-17得分为(6.83±4.68)分,对照组得分为(7.20±4.60)分,重复测量方差分析显示,时间效应有统计学意义(P<0.001),组间效应、交互作用无统计学意义(P>0.05)。MCCB得分上,连线测试、符号编码、语言记忆、空间广度、数字序列、迷宫测验、视觉记忆、情绪管理、持续操作时间主效应有统计学意义(P<0.001);语言记忆、数字序列、视觉记忆、言语流畅性、持续操作组间效应有统计学意义(P<0.05);语言记忆、持续操作交互作用具有统计学意义(P<0.05)。干预结束后定向力恢复时长研究组短于对照组[(508.57±104.48)s vs.(631.66±212.27)s],差异具有统计学意义(P<0.05)。两组间不良反应发生率(28.6%vs.40.0%)差异无统计学意义(P>0.05)。结论RUL-MECT与双侧刺激MECT相比,抗抑郁疗效相当,对认知功能改善及定向力恢复要优于双侧刺激组MECT。

无抽搐电休克治疗对中青年抑郁患者认知功能影响及性别差异

目的初步探索无抽搐电休克治疗(modified electroconvulsive therapy,MECT)对中青年抑郁发作患者认知功能的影响及其性别差异。方法纳入首都医科大学附属北京安定医院住院的中青年抑郁发作患者,完成6次MECT,分别在基线、第3次MECT后、第6次MECT后采用17项汉密尔顿抑郁量表(17-item Hamilton depression scale,HAMD-17)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、重复成套神经心理状态测验(repeatable battery for the assessment of neuropsychological status,RBANS)对抑郁、焦虑症状和认知功能进行评分,分别在青年组和中年组中比较性别差异。结果纳入抑郁发作患者共122例,其中青年组83例、中年组39例。两组中,基线HAMD及HAMA评分、MECT后HAMD减分率均无性别差异(P>0.05)。重复测量方差分析显示,青年组中,RBANS总分、视觉广度因子分、注意因子分的时点效应具有统计学意义(P<0.05),治疗后较基线时提高,性别分组效应和交互效应无统计学意义(P>0.05)。中年组中,RBANS总分、视觉广度因子分的时点-性别分组交互效应具有统计学意义(P<0.05),女性患者RBANS总分、视觉广度因子分、注意因子分在第6次MECT后较基线时提高(P<0.05),时点效应和性别分组效应无统计学意义(P>0.05)。结论中青年抑郁患者MECT后认知功能整体有所改善,中年患者认知功能变化存在性别差异,需依据患者性别、年龄特征优化MECT方案,以减轻认知功能不良影响。

多发性硬化的治疗进展

多发性硬化(multiple sclerosis,MS)是一种慢性中枢神经系统炎症性脱髓鞘疾病,随着人们对MS发病机制了解的深入,MS的治疗手段也在不断更新。近年来,新上市的疾病修饰治疗(disease-modifying therapy,DMT)药物层出不穷,临床研究显示出良好的疗效及安全性。治疗策略及目标也在更新。本文主要对近年来新上市的DMT药物的作用机制、疗效以及安全性进行综述,此外对治疗策略、治疗目标以及正在研发的新药也做了简要介绍,以期为临床决策的制定提供参考。

精神科医师对MECT应用于儿童与青少年精神障碍患者的认知情况调查

目的调查精神科医师对无抽搐电休克治疗(MECT)应用于儿童与青少年精神障碍患者的认知情况。方法采用一般资料调查表、MECT的基本知识和经验调查问卷、对儿童与青少年精神障碍患者应用MECT的经验和知识调查问卷、对儿童与青少年患者应用MECT疗效和不良反应认知情况调查问卷、对儿童与青少年精神障碍患者应用MECT态度调查问卷调查中原地区63家医院的138名精神科医师对MECT应用儿童与青少年精神障碍患者的认知情况。结果不同级别医院精神科医师在有MECT相关基本知识方面,未给所管理的患者做过MECT应用、如何评估自己对于患者应用MECT的知识方面,MECT对患者记忆力有无长期不良影响、MECT对患者注意力和专注力有无长期不良影响的认知方面,具有严重精神障碍的青少年(13~17岁)使用MECT方面的比较,差异均有统计学意义(P<0.05或0.01)。结论不同级别医院精神科医师对MECT应用于儿童与青少年精神障碍患者的认知和使用方面,均存在差异,有必要建立区域性或全国性MECT数据中心,制定MECT指南,为儿童与青少年精神障碍的治疗提供指导。

基于疾病修饰的大疱性类天疱疮治疗进展

大疱性类天疱疮(bullous pemphigoid,BP)主要治疗方式为使用糖皮质激素和免疫抑制剂,而长期使用这些药物可能出现严重的不良反应,且病情复发率较高。近年来,随着BP疾病修饰的相关研究不断深入,BP的靶向治疗受到很大关注,越来越多的新型药物应用于临床。本文基于BP疾病修饰的相关研究,对当前BP新靶点药物的研究进展进行综述。

摆位误差对乳腺癌术后放疗患者心脏剂量影响

目的研究模拟摆位误差对左侧乳腺癌患者术后放疗心脏受照剂量的影响。方法选取17例左侧乳腺癌根治术后进行调强放疗的患者为研究对象。在计划系统中,模拟靶区中心相对于计划射野中心的偏移,包括向颅(S)、尾(I)、左(L)、右(R)、前(A)和后(P)各移动5 mm,并评估心脏受照剂量,分析不同方向的摆位误差对心脏剂量的影响。结果原始计划心脏平均剂量(Dmean)为5.72 Gy。射野中心向6个不同方向移动5 mm后,L、A、S方向心脏受照剂量减少,R、P、I方向心脏受照剂量增加,P方向心脏Dmean增加(1.46±0.24)Gy,R方向心脏Dmean增加(1.14±0.17)Gy,I方向心脏Dmean增加(0.43±0.25)Gy。结论左侧乳腺癌改良根治术后放疗,向R、P、I方向的摆位误差可增加心脏受照剂量,向L、A、S方向的摆位误差可减少心脏受照剂量。

Fe_(3)O_(4)磁性纳米颗粒的修饰及在肿瘤治疗中的应用

综述了对四氧化三铁磁性纳米颗粒(Fe_(3)O_(4)-MNPs)的功能化修饰以及其在肿瘤治疗中的应用。重点阐述了无机纳米粒子和有机聚合物对Fe_(3)O_(4)-MNPs的修饰,以提升磁性纳米材料的稳定性、分散性及生物相容性;以及Fe_(3)O_(4)-MNPs在治疗中作为药物载体、磁热疗、磁共振成像、光动力疗法以及多功能肿瘤治疗体系的应用等。讨论了Fe_(3)O_(4)-MNPs在应用过程中可能存在的问题并对未来的发展进行了展望。Fe_(3)O_(4)-MNPs的大小、形状和剂量将会是评估的首要指标,在治疗应用过程中的细胞毒性问题或将成为关键难题。通过寻求新的修饰材料,合成多功能、成本低以及应用方便地Fe_(3)O_(4)-MNPs是今后主要的研究热点。