肿瘤坏死因子α对心肌细胞内受磷蛋白表达和细胞内钙的调节作用

目的探讨肿瘤坏死因子α(TNFα)对培养的乳鼠心肌细胞内受磷蛋白(PLB)和肌浆网钙泵蛋白同功酶(SERCA2a)基因表达及细胞内游离钙离子浓度的影响。方法体外培养的乳鼠心肌细胞被随机分成对照组和不同浓度TNFα(1、10、30、50、70μg/L)干预组,用单管一步法逆转录聚合酶链反应(RT-PCR)和Westernblotting技术,观察TNFα对乳鼠心肌细胞PLB和SERCA2a基因表达的影响。采用Fluo-3/Am荧光染色剂负载细胞,在激光共聚焦显微镜下测定TNFα对单个乳鼠心肌细胞内游离钙离子浓度的影响。结果TNFα浓度依赖性增高PLBmRNA和蛋白质的表达,10、30、50、70μg/LTNFα组PLBmRNA表达量分别较对照组增加66%、106%、141%、189%(P<0.05),蛋白质的表达分别较对照组提高30%、48%、73%、114%(P<0.001)。而1μg/LTNFα组与对照组PLBmRNA和蛋白质表达差异均无显著性。TNFα不影响SERCA2a的表达。50μg/LTNFα作用细胞24h,能降低异丙肾上腺素刺激的[Ca2+]i变化幅度的增高,[Ca2+]i变化幅度较对照组减少33%(P<0.01),但对静息状态下[Ca2+]i变化幅度无影响。结论TNFα可增强心肌细胞内PLB的表达,降低心肌细胞内[Ca2+]i的变化,这可能与TNFα对心肌细胞的负性肌力作用有关。

比较度洛西汀治疗一级亲属情感障碍家族史阳性或阴性的抑郁症患者的疗效（英文）

背景:阳性情感障碍家族史能否预测抗抑郁药疗效尚不清楚。目的:评估情感障碍家族史与度洛西汀治疗抑郁症的疗效之间的相关性。方法:研究纳入符合国际疾病分类第10版中抑郁症定义的77例患者,采用标准剂量的度洛西汀治疗12周。其中37例患者有情感障碍家族史(一级亲属中),另外40例家族史阴性。采用汉密尔顿抑郁量表(Hamilton Depression rating scale,HAMD-17)、汉密尔顿焦虑量表(Hamilton Anxiety rating scale,HAMA)、抗抑郁药副反应量表(Side Effects Rating Scale,SERS)、斯奈思-汉密尔顿快感量表(Snaith-Hamilton Pleasure Scale,SHAPS)和贝克抑郁自评量表(Beck Depression Inventory,BDI)在基线与纳入研究后第2、4、6、8、12周末对患者进行评估。采用重复测量方差分析和logistic回归分析情感障碍家族史与度洛西汀疗效之间的相关性。结果:情感障碍阳性家族史的患者发病较早,病程较长,精神性焦虑水平更高,而且快感缺乏更加突出。重复测量方差分析显示经过12周治疗抑郁症严重程度显著改善,但两组之间的改善幅度或速度没有显著差异。情感障碍家族史阳性的患者中有75.7%治疗有效(即HAMD-17总分较基线下降>50%),而家族史阴性的患者有77.5%有效(X2=0.04,p=0.850)。结论:情感障碍家族史与度洛西汀对抑郁症的急性期治疗的疗效不相关。

Effects of the Lifting Manipulation of Scalp Acupuncture for Raising Myodynamia of the Affected Limbs in Hemiplegic Patients Due to Cerebral Thrombosis

Objective: To provide a new therapy with definite quality controllable therapeutic effects for functional restoration of the affected limbs in hemiplegic patients due to cerebral thrombosis. Method: 180 patients with hemiplegia due to cerebral thrombosis were randomly divided into 2 groups: the treatment group (treated with scalp acupuncture by using the lifting manipulation) and the control group (treated with scalp acupuncture by using the twirling manipulation). Evaluations were given for the two groups based on the improvement of myodynamia and comprehensive functions after the treatment. Results: Both groups showed increased myodynamia, but with different cured and much relieved rates (86.67% in the treatment group and 5% in the control group, P＜0.01). Conclusion: Scalp acupuncture with the lifting manipulation can dramatically increase myodynamia of the affected limbs in hemiplegic patients due to cerebral thrombosis.

Thirty Cases of Obsession Treated by Point-Stimulation and with Small Dose of Chlorimipramine

Objective: To investigate the clinical therapeutic effects of point-stimulation for obsession. Methods: Sixty cases of obsession were divided into two groups: a control group of 30 cases treated with chlorimipramine (Ch1), and a treatment group of 30 cases treated by point-stimulation (PS) plus chlorimipramine (PS+Chl). The therapeutic effects and side-effect were evaluated according to the criteria set in Yale-Brown Obsession Scale (Y-BOCS), Hamilton's depression scale (HAMD), brief psychiatric rating scale (BPRS) and treatment emergent symptom scale (TESS). Results: The cure rate and markedly effective rate were respectively 26.7% and 56.6% in the control group, and 43.3% and 50% in the treatment group, suggesting that the therapeutic effect in the treatment group was better than that in the control group. The incidence of adverse side-effects was 73.33% in the control group and 46.67% in the treatment group, with a significant difference between the two groups (P<0.05). Conclusion: Point-stimulation plus small dose of chlorimipramine was superior to the simple chlorimipramine treatment, indicating that the combined method was more effective and safe for obsession with less side effects.

Case report of Cushing＇s syndrome with an acute psychotic presentation

一位36岁的中国女性因出现狂躁、被害妄想和自杀意念3天被送至某综合医院急诊。六个月来患者易醒、过度警觉并出现躯体症状。入心身病房后,体检发现该患者满月脸、突眼,且双腿有紫纹,因此考虑急性精神症状继发于库欣综合征。血浆皮质醇、促肾上腺皮质激素(adrenocorticotropic hormone ACTH)水平升高,腹部计算机断层扫描(computed tomography,CT)发现左肾上腺肿块,证实了该诊断。使用小剂量喹硫平(75-125 mg/d)和阿普唑仑(0.4 mg/qn)来控制精神病性症状并改善其睡眠。将一个良性的非ACTH依赖性肾上腺肿瘤手术切除后,患者的皮质醇和ACTH水平恢复正常,其精神症状也在一个月内逐渐减少,此时该患者出院。患者出院后一直门诊随诊,维持喹硫平治疗(因为担心停药对睡眠和情绪稳定的影响),总时间持续1年左右,剂量从50mg渐减至25mg至减停。这时她的精神症状已经完全消失。该病例中,病人具有库欣综合征的特殊症状,因此相对容易诊断;但在库欣综合征中急性精神病性症状可能会危及生命,也可能不出现库欣综合征的典型躯体症状(如果皮质醇增多症不严重),所以临床精神科医师在鉴别难以解释的急性精神病时,应该始终考虑将库欣综合征纳入可能的鉴别诊断。

Clinical Study on Treatment of the Earthquake-caused Post-traumatic Stress Disorder by Cognitive-behavior Therapy and Acupoint Stimulation

Objective: To study the curative effect of acupoint stimulation on the earthquake-caused post-traumatic stress disorder (PTSD). Methods: The 91 PTSD patients in Wenchuan hit by a strong earthquake were randomly divided into a control group of 24 cases treated by the cognitive-behavior therapy, and a treatment group of 67 cases treated by both cognitive-behavior therapy and acupoint stimulation. The scores were evaluated according to Chinese version of the incident effect scale revised (IES-R) and the self-compiled questionnaire for the major post-traumatic psychological condition, and the curative effect was compared between the two groups. Results: The total scores of IES-R, the scores of all factors and the total scores of the questionnaire in the two groups after treatment were much lower than those before treatment (P<0.01). The comparison of reduction in the factor scores between the two groups showed that the curative effect in the treatment group was better that ofin the control group. Conclusion: The acupoint stimulation is effective for the PTSD patients, with better results than that of cognitive-behavior therapy used

Multi-central Clinical Research into Treating 80 Cases of Chronic Thrombocytopenia with Qi-supplementing and Yin-nourishing Therapy and Western Medicine

Objective: To probe the effects of qi-supplementing and yin-nourishing therapy (blood-increasing decoction and blood generating powder) on chronic thrombocytopenia. Methods: Two hundred patients with chronic thrombocytopenia were randomly divided into control (n=100) and test groups (n = 100) with Amino-polypeptide as a basic treatment for both. Test group patients consumed a blood-increasing decoction and blood-generating powder for 1-3 months. Improvements in platelet counts and TCM syndrome were observed. Results: One hundred and sixty-four (80 in the test group and 84 in the control group) of 189 total participants were treated for 3 months. The total effective rate in improving TCM syndrome was 95.00% in the test group and 79.76% in the control group (P<0.05). There was significant difference (P<0.05) in the accumulated score of TCM syndrome between the two groups treated at different time points. The total effective rate of platelet counts was 86.25% in the test group and 59.52% in the control group (P<0.05). There was a significant difference in platelet counts before and after treatment in the two groups (P<0.05). There was no significant differences in platelet count between the two groups treated for 1-2 months; however, a significant difference was found between the two groups after treatment for 3 months (P<0.05). Conclusions: After a 3-month treatment of chronic thrombocytopenia patients with qi-supplementing and yin-nourishing therapy, TCM syndrome was improved and platelet counts increased with no obvious side effects, and the quality of life of the participants was enhanced with noticeable long-term curative effects.