• 【DSM-IV型人格障碍的结构已在临床医生评级中显示。】 复制标题 收藏 收藏
    DOI:10.1016/j.comppsych.2012.10.014 复制DOI
    作者列表:Blais MA,Malone JC
    BACKGROUND & AIMS: :The revisions proposed for the DSM-5 would greatly alter how personality pathology is conceptualized, assessed, and diagnosed. One aspect of the proposed changes, elimination of four current personality disorders, has raised considerable controversy. The present study attempts to inform this debate by exploring clinicians' views of the structure of Personality Disorders using the current diagnostic system, the DSM-IV. An exploratory factor analysis was conducted on the DSM-IV Personality Disorder criteria using clinician ratings for 280 patients. The factor analysis revealed eight clear and meaningful factors. The eight factors contained all six personality disorders proposed for retention in DSM-5 but also contained clear representations of two disorders (Paranoid and Schizoid) identified for removal from the system. These conditions appear to have clinical utility and their removal may have unintended negative consequences in clinical practice. Dependent and Avoidant criteria also merged to form a new construct with interesting clinical implications. These findings provide new insights into the complex typologies clinicians employ when applying the DSM-IV system to personality disordered patients. Lastly we argue that successful refinement of clinically significant constructs, like diagnostic systems, requires a balanced appraisal of evidence for clinical utility as well as external and internal validity.
    背景与目标: :针对DSM-5提出的修订将极大地改变人格病理学的概念化,评估和诊断方式。所提议的改变的一方面,消除了当前的四种人格障碍,引起了相当大的争议。本研究试图通过使用当前的诊断系统DSM-IV探索临床医生对人格障碍结构的看法来为这场辩论提供信息。使用临床医师评估的280名患者,对DSM-IV人格障碍标准进行了探索性因素分析。因素分析揭示了八个明确而有意义的因素。八个因素既包含提议保留在DSM-5中的所有六个人格障碍,也包含明确识别出的两种人格障碍(Paranoid和Schizoid),可以从系统中移除。这些情况似乎具有临床用途,将其清除可能会在临床实践中产生意想不到的负面影响。受抚养者和回避者的标准也合并在一起,形成了一种具有有趣临床意义的新结构。这些发现为临床医生在将DSM-IV系统应用于人格障碍患者时采用的复杂类型提供了新的见解。最后,我们认为要成功地完善具有临床意义的结构(如诊断系统),需要对临床实用性以及内部和外部有效性的证据进行均衡的评估。
  • 【从抑制到激活,从情绪低反应到情绪高反应:区分躁郁症的两种途径。】 复制标题 收藏 收藏
    DOI:10.1016/j.psychres.2012.10.008 复制DOI
    作者列表:Atzeni T,Henry C,Minois I,Gard S,Desage A,Zanouy L,M'bailara K
    BACKGROUND & AIMS: :To better explore the clinical heterogeneity of bipolar mood states, we developed a dimensional scale for assessing all mood episodes (depressive, hypomanic, manic, mixed states) using the same tool. The Multidimensional Assessment of Thymic States (MATHYS) (Henry et al., 2008) provides two scores, a total score measuring a level of activation and a sub-score of emotional reactivity. The aim of this study was to establish the appropriate cut-off in total activation versus inhibition and in the emotional reactivity sub-score in bipolar disorders. Patients (n=187) during an acute episode and controls (n=89) filled in the MATHYS. Receiver Operating Characteristic (ROC) curves were obtained to estimate the sensitivity and specificity of the global score and the emotional reactivity sub-score of the MATHYS, in order to differentiate patients from controls. ROC curves showed very satisfactory sensitivity and specificity levels both for the total score and the sub-score of emotional reactivity, thus providing an appropriate cut-off. Concerning the total score between 0 and 200, patients with a score lower than 91 had significant global inhibition and those with a score higher than 109 had significant global activation. Regarding the emotional reactivity sub-score between 0 and 40, patients with a score lower than 16 had significant emotional hyporeactivity and those with a score higher than 24 had significant emotional hyperreactivity. Our results provide cut-offs for the MATHYS to identify patients in an acute phase.
    背景与目标: :为了更好地探索双相情感状态的临床异质性,我们开发了一种用于使用同一工具评估所有情绪事件(抑郁,躁狂,躁狂,混合状态)的量表。胸腺状态的多维评估(MATHYS)(Henry等,2008)提供了两个评分,一个总评分用于衡量激活水平,另一个是情感反应分数。这项研究的目的是确定双相情感障碍的总激活与抑制以及情绪反应性亚评分的适当分界。急性发作期间的患者(n = 187)和对照组(n = 89)填写了MATHYS。获得接收者操作特征(ROC)曲线以估计MATHYS总体评分和情绪反应性子评分的敏感性和特异性,以区分患者与对照组。 ROC曲线在总分和情绪反应的亚评分中均显示出非常令人满意的敏感性和特异性水平,因此提供了适当的临界值。关于总分在0到200之间,得分低于91的患者具有显着的总体抑制作用,得分高于109的患者具有显着的全局抑制作用。关于0至40之间的情绪反应分数,得分低于16的患者有明显的情绪低反应性,而得分高于24的患者则有明显的情绪高反应性。我们的结果为MATHYS识别急性期患者提供了界限。
  • 【HLA-G * 14bp插入和KIR2DS1-HLAC2复合物对自闭症谱系障碍儿童行为障碍的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.neuroscience.2017.06.012 复制DOI
    作者列表:Guerini FR,Bolognesi E,Chiappedi M,Ghezzo A,Manca S,Zanette M,Sotgiu S,Mensi MM,Zanzottera M,Agliardi C,Costa AS,Balottin U,Clerici M
    BACKGROUND & AIMS: :Activating KIR-HLA-C ligand complexes and HLA-G∗14bp insertion/deletion (+/-) polymorphism were associated to Autism Spectrum Disorders (ASD) and were suggested to correlate with inflammation during fetal development. We evaluated whether HLA-G∗14bp(+/-) and KIR-HLA-C complexes are associated with cognitive and behavioral scores and EEG profile in 119 ASD children (58 from Sardinia, 61 from Peninsular Italy). KIR2DS1-C2; KIR2DS2-C1; KIR2DL1-C2; KIR2DL2-C1; KIR2DL3-C1 and HLA-G∗14bp(+/-) were molecularly genotyped by Single Specific Primer PCR and gel electrophoresis. Univariate linear model analysis adjusted for age, gender and provenience showed statistically higher scores of Childhood Autism Rating Scale (CARS) and Autistic Core Behavior in KIR2DS1-C2+/HLA-G∗14bp+ASD children (43.7±1.5, p=0.03; 3.3±0.1, p=0.03, respectively). These results suggested a synergistic polygenic association of KIR2DS1-HLAC2+/HLA-G∗14bp+ pattern with behavioral impairment in ASD children.
    背景与目标: :激活的KIR-HLA-C配体复合物和HLA-G * 14bp插入/缺失(/-)多态性与自闭症谱系障碍(ASD)相关,并被认为与胎儿发育过程中的炎症相关。我们评估了119名ASD儿童(58名来自撒丁岛,61名来自意大利半岛)的HLA-G * 14bp(/-)和KIR-HLA-C复合物是否与认知和行为评分以及脑电图谱相关。 KIR2DS1-C2; KIR2DS2-C1; KIR2DL1-C2; KIR2DL2-C1;通过单特异性引物PCR和凝胶电泳对KIR2DL3-C1和HLA-G * 14bp(/-)进行分子基因分型。根据年龄,性别和出身水平进行的单变量线性模型分析显示,在KIR2DS1-C2 / HLA-G * 14bp ASD儿童中,儿童自闭症评分量表(CARS)和自闭症核心行为的统计学得分较高(43.7±1.5,p = 0.03; 3.3±分别为0.1,p = 0.03)。这些结果表明,KIR2DS1-HLAC2 / HLA-G * 14bp模式与ASD儿童的行为障碍存在协同的多基因关联。
  • 【饮食抗拒性改变患者的综合治疗训练模型】 复制标题 收藏 收藏
    DOI:10.3305/nh.2012.27.3.5690 复制DOI
    作者列表:Calvo Sagardoy R,Gallego Morales LT,García de Lorenzo y Mateos A
    BACKGROUND & AIMS: :The need to find effective treatments for patients with Anorexia or Bulimia nervosa has led to the professionals who care for them to develop new forms of treatment that take into account the variables that cause resistance to change. Patients in this study (2006-2009) have the following characteristics: 340 patients who have 7 or more years of evolution and/or have tried numerous previous treatments without having succeeded in starting and / or maintaining the desired changes, that allowed them to recover steadily. As the proposed treatment, the patient-treatment team is based on the principles of the training model. It considers the patient holistically, it informs and provides him with resources to increase its commitment to change. Teaches the patient to take care physically and mentally as a way to regain their health and leave the disorder in a stable way. Includes family members as essential support in the recovery of their closest. Therapists require extensive experience in the treatment of ED, flexibility, ability to integrate with other team members even if they use different theoretical models, skills for group sessions, ability to handle negative emotions and frustration tolerance. Finally, the model presented below has been implemented, recovered patients whose stay in the disorder exceeded 15 years of development and led to permanent occupational disability.
    背景与目标: 由于需要为患有厌食症或神经性贪食症的患者找到有效的治疗方法,因此引起了专业人士的关注,他们开发出了新的治疗形式,并考虑到了引起抗药性变化的因素。本研究(2006-2009年)的患者具有以下特征:340位患者经历了7年或更长时间的进化和/或尝试过许多先前的治疗而未成功开始和/或维持所需的改变,从而使他们得以康复稳步。作为建议的治疗方法,患者治疗团队基于培训模型的原则。它从整体上考虑患者,为患者提供信息并为其提供资源,以增加其对变化的承诺。教给病人身心上的照顾,以恢复健康并稳定地摆脱疾病。包括家庭成员,以帮助他们恢复最亲密的关系。治疗师需要在ED的治疗方面具有丰富的经验,灵活性,与其他团队成员融为一体的能力,即使他们使用不同的理论模型,小组会议的技能,应对负面情绪的能力和挫败感的容忍度也是如此。最终,实施了以下模型,恢复了在该疾病中停留超过15年并导致永久性职业残疾的患者。
  • 【一般实践中,抑郁症症状和疾病的综合护理与常规护理[混合]:一项非劣效性随机试验的研究方案。】 复制标题 收藏 收藏
    DOI:10.1186/s12888-017-1376-1 复制DOI
    作者列表:Massoudi B,Blanker MH,van Valen E,Wouters H,Bockting CLH,Burger H
    BACKGROUND & AIMS: BACKGROUND:The majority of patients with depressive disorders are treated by general practitioners (GPs) and are prescribed antidepressant medication. Patients prefer psychological treatments but they are under-used, mainly due to time constraints and limited accessibility. A promising approach to deliver psychological treatment is blended care, i.e. guided online treatment. However, the cost-effectiveness of blended care formatted as an online psychological treatment supported by the patients' own GP or general practice mental health worker (MHW) in routine primary care is unknown. We aim to demonstrate non-inferiority of blended care compared with usual care in patients with depressive symptoms or a depressive disorder in general practice. Additionally, we will explore the real-time course over the day of emotions and affect, and events within individuals during treatment. METHODS:This is a pragmatic non-inferiority trial including 300 patients with depressive symptoms, recruited by collaborating GPs and MHWs. After inclusion, participants are randomized to either blended care or usual care in routine general practice. Blended care consists of the 'Act and Feel' treatment: an eight-week web-based program based on behavioral activation with integrated monitoring of depressive symptomatology and automatized feedback. GPs or their MHWs coach the participants through regular face-to-face or telephonic consultations with at least three sessions. Depressive symptomatology, health status, functional impairment, treatment satisfaction, daily activities and resource use are assessed during a follow-up period of 12 months. During treatment, real-time fluctuations in emotions and affect, and daily events will be rated using ecological momentary assessment. The primary outcome is the reduction of depressive symptoms from baseline to three months follow-up. We will conduct intention-to-treat analyses and supplementary per-protocol analyses. DISCUSSION:This trial will show whether blended care might be an appropriate treatment strategy for patients with depressive symptoms and depressive disorder in general practice. TRIAL REGISTRATION:Netherlands Trial Register: NTR4757; 25 August 2014. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4757 . (Archived by WebCite® at http://www.webcitation.org/6mnXNMGef ).
    背景与目标: 背景:大多数抑郁症患者均由全科医生(GPs)进行治疗,并开了抗抑郁药。患者偏爱心理治疗,但由于时间紧迫且可及性有限,因此未得到充分利用。提供心理治疗的一种有前途的方法是混合护理,即指导性在线治疗。但是,由患者自己的全科医生或全科医生精神保健工作者(MHW)支持的在线初级心理保健形式的混合保健在常规初级保健中的成本效益尚不清楚。我们的目标是证明在一般情况下,患有抑郁症症状或抑郁症患者的混合护理与常规护理相比不劣于常规护理。此外,我们将探讨情绪,情感和治疗过程中个体内部事件的全天实时过程。
    方法:这是一项务实的非自卑性试验,包括GP和MHW的协作招募的300例抑郁症患者。纳入后,将参与者随机分为常规常规护理中的混合护理或常规护理。混合护理由“行为与感觉”治疗组成:这是一个基于行为激活的八周基于网络的计划,具有对抑郁症状和自动反馈的集成监控。 GP或他们的MHW通过至少三节的定期面对面或电话咨询来指导参与者。在12个月的随访期内评估抑郁症状,健康状况,功能障碍,治疗满意度,日常活动和资源使用情况。在治疗过程中,情绪和情感的实时波动以及日常事件将使用生态瞬时评估进行评估。主要结果是抑郁症状从基线减少到三个月的随访。我们将进行意向性治疗分析和补充的按方案分析。
    讨论:该试验将表明在一般实践中,混合护理是否可能是抑郁症和抑郁症患者的合适治疗策略。
    试用注册:荷兰试用注册:NTR4757; 2014年8月25日。http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4757。 (由WebCite®存档,网址为http://www.webcitation.org/6mnXNMGef)。
  • 【墨西哥传统医学中用于治疗胃肠道疾病的某些植物的痉挛潜力。】 复制标题 收藏 收藏
    DOI:10.1016/S0944-7113(11)80049-8 复制DOI
    作者列表:Rojas A,Cruz S,Rauch V,Bye R,Linares E,Mata R
    BACKGROUND & AIMS: :The present investigation describes the effect on the isolated rat ileum of methanolic extracts derived from Conyza filaginoides (D. C.) Hieron (Asteraceae), Croton fragilis HBK. (Euphorbiaceae), Dodonaea viscosa Jacq. (Sapindaceae), Gymnosperma glutinosum (Spreng) Less. (Asteraceae), Parthenium tomentosum DC. var. stramonium (Greene) Rollins (Asteraceae), Potentilla thurberi A. Gray (Rosaceae), Pterogonum atrorubens (Englem.) H. Gross (Polygonaceae), Zornia venosa Mohlenbr. (Fabaceae) and Datura lanosa Barclay ex Bye (Solanaceae). In all the cases the extracts inhibited, in a concentration-dependent manner, the spontaneous contraction of the intestinal smooth muscle. The most active extract was that of D. viscosa. These findings tend to support the ethnomedical use of the selected species as spasmolytic agents in Mexican traditional medicine. Additionally, the potential antimicrobial activity of the extracts against pathogenic enterobacteria was investigated. Seven of the nine plants evaluated displayed antibacterial effects.
    背景与目标: :本研究描述了从Conyza filaginoides(D. C.)Hieron(Asteraceae),脆弱的巴豆HBK提取的甲醇提取物对离体大鼠回肠的作用。 (大戟科),Dodonaea viscosa Jacq。 (无患子科),裸子植物(Gymnosperma glutinosum)(Spreng)少。 (菊科),Parthenium tomentosum DC。变种amo(Greene)罗林斯(菊科),委陵菜A. Gray(蔷薇科),翼龙(Pterogonum atrorubens)(英)H. Gross(Po科),百日草(Zornia venosa Mohlenbr)。 (Fabaceae)和Datura lanosa Barclay ex Bye(Solanaceae)。在所有情况下,提取物均以浓度依赖性方式抑制肠平滑肌的自发收缩。活性最高的提取物是粘枝梭状芽胞杆菌。这些发现倾向于支持在种族学上将所选物种用作墨西哥传统医学中的解痉剂。此外,还研究了提取物对病原性肠杆菌的潜在抗菌活性。评估的9株植物中有7株显示出抗菌作用。
  • 【来自印度三级护理中心的原发性免疫缺陷疾病的综合报告。】 复制标题 收藏 收藏
    DOI:10.1007/s10875-012-9829-2 复制DOI
    作者列表:Madkaikar M,Mishra A,Desai M,Gupta M,Mhatre S,Ghosh K
    BACKGROUND & AIMS: OBJECTIVES:There is paucity of data on Primary immunodeficiency disorders (PID) from India. Here we describe the frequency of different primary immunodeficiency disorders, their clinical features and disease complications of 159 patients with PID diagnosed in a tertiary care center from India over the last 3 years. METHODS:We retrospectively reviewed the records of all the patients identified to have specific PID from 2008 to 2011. The diagnosed patients were classified according to guidelines of International Union of Immunological Society (IUIS) into eight different sub groups. RESULTS:The distribution pattern was as follows: diseases of immune dysregulation (29 %), phagocytic defects (29 %), predominant antibody deficiency (13 %), combined T and B cell deficiency (19 %) and other well defined diseases (10 %). CONCLUSION:The distribution pattern of PID varied significantly from those reported by western studies. This study highlights the need for development of more advanced facilities for diagnosis and management of PID in India and also the need for establishing population and hospital based registries.
    背景与目标: 目的:印度缺乏有关原发性免疫缺陷疾病(PID)的数据。在这里,我们描述了过去3年间在印度三级护理中心诊断的159例PID的不同原发性免疫缺陷疾病的发生率,其临床特征和疾病并发症。
    方法:我们回顾性回顾了2008年至2011年所有被鉴定为具有特定PID的患者的记录。根据国际免疫学会联合会(IUIS)的指南,将诊断出的患者分为八个不同的亚组。
    结果:分布模式如下:免疫失调疾病(29%),吞噬缺陷(29%),主要抗体缺乏症(13%),T和B细胞联合缺乏症(19%)和其他明确疾病(10) %)。
    结论:PID的分布模式与西方研究报道的存在显着差异。这项研究强调了在印度开发用于PID诊断和管理的更先进设施的需求,以及建立以人口和医院为基础的注册表的需求。
  • 8 Integrative neuroimaging in mood disorders. 复制标题 收藏 收藏

    【情绪障碍中的综合性神经影像学。】 复制标题 收藏 收藏
    DOI:10.1097/YCO.0b013e32835a0b63 复制DOI
    作者列表:Keedwell PA,Linden DE
    BACKGROUND & AIMS: PURPOSE OF REVIEW:Neuroimaging has become a central technique of biological psychiatry and is uniquely suited to assess functional and structural brain changes in psychiatric patients in vivo. In this review, we highlight several recent developments that may enable the transition of psychiatric neuroimaging from laboratory to clinic. RECENT FINDINGS:We describe recent trends in refining imaging techniques for brain microstructure (diffusion imaging) and neurochemistry (magnetic resonance spectroscopy of neurotransmitters and metabolites) and their application to patients with mood disorders and individuals at risk, such as first-degree relatives. We also survey recent progress in imaging-guided deep brain stimulation (DBS), imaging-based (neurofeedback) therapies and studies looking at their convergent anatomical targets. These new interventional techniques, which aim to modulate brain circuits of emotion and motivation highlighted by functional imaging studies, have shown promising effects in several small studies. SUMMARY:The mapping of brain patterns associated with risk to develop mood disorders may pave the way for diagnostic/prognostic applications of neuroimaging. The neuromodulation techniques of DBS and neurofeedback, which target dysfunctional or compensatory circuits identified by functional imaging, may take neuroimaging into a new, therapeutic domain.
    背景与目标: 审查的目的:神经影像学已成为生物学精神病学的中心技术,并且特别适合于评估体内精神病患者体内功能和结构的大脑变化。在这篇综述中,我们重点介绍了可能使精神神经影像学从实验室过渡到临床的最新进展。
    最近的发现:我们描述了用于脑微结构(扩散成像)和神经化学(神经递质和代谢产物的磁共振波谱)的精细成像技术的最新趋势,以及它们在情绪障碍患者和高危人群(例如一级亲属)中的应用。我们还调查了影像引导的深部脑刺激(DBS),基于影像的(神经反馈)疗法和研究其趋同的解剖学目标的最新进展。这些新的干预技术旨在调节功能成像研究所强调的情绪和动机的大脑回路,在一些小型研究中显示出了令人鼓舞的效果。
    摘要:与发展情绪障碍风险相关的大脑模式的映射可能为神经影像的诊断/预后应用铺平道路。 DBS和神经反馈的神经调节技术,以功能成像确定的功能障碍或代偿性电路为目标,可能会将神经成像带入新的治疗领域。
  • 【轴突运输和轴突运输疾病的遗传学。】 复制标题 收藏 收藏
    DOI:10.1371/journal.pgen.0020124 复制DOI
    作者列表:Duncan JE,Goldstein LS
    BACKGROUND & AIMS: :Neurons are specialized cells with a complex architecture that includes elaborate dendritic branches and a long, narrow axon that extends from the cell body to the synaptic terminal. The organized transport of essential biological materials throughout the neuron is required to support its growth, function, and viability. In this review, we focus on insights that have emerged from the genetic analysis of long-distance axonal transport between the cell body and the synaptic terminal. We also discuss recent genetic evidence that supports the hypothesis that disruptions in axonal transport may cause or dramatically contribute to neurodegenerative diseases.
    背景与目标: 神经元是具有复杂结构的专门细胞,包括复杂的树突状分支和从细胞体延伸到突触末端的长而狭窄的轴突。需要有组织的重要生物材料在整个神经元中进行运输,以支持其生长,功能和生存能力。在这篇综述中,我们集中于从细胞体与突触末端之间的远距离轴突运输的遗​​传分析中得出的见解。我们还讨论了最新的遗传学证据,这些证据支持以下假设:轴突运输中断可能导致或严重导致神经退行性疾病。
  • 【在有冠心病危险的患者中管理高血清胆固醇和相关疾病。】 复制标题 收藏 收藏
    DOI:10.1016/s0002-9343(97)00462-2 复制DOI
    作者列表:Grundy SM
    BACKGROUND & AIMS: Cholesterol lowering has been shown to be of benefit in reducing the risk of coronary heart disease (CHD) in both patients with established CHD (secondary prevention) and those without (primary prevention). In secondary prevention trials, moderate cholesterol lowering reduced the rate of new events and decreased both morbidity and mortality from cardiovascular disease. In primary prevention, a reduction of cholesterol by 20% has produced a 31% reduction in recurrent coronary morbidity, a 33% reduction in coronary mortality, and 22% less total mortality. The target of therapy is low-density lipoprotein (LDL) cholesterolin patients with established CHD, goal LDL is < or = 100 mg/dL. In high-risk patients without established CHD, the target goal for LDL cholesterol is < or = 130 mg/dL. Nondrug measures, bile acid sequestrants, nicotinic acid, and 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors all play important roles in cholesterol-lowering therapy.

    背景与目标: 胆固醇降低已被证明在既有冠心病(二级预防)和非冠心病(一级预防)患者中均能降低冠心病(CHD)的风险。在二级预防试验中,适度降低胆固醇可降低新事件的发生率,并降低心血管疾病的发病率和死亡率。在一级预防中,降低20%的胆固醇可使复发性冠心病的发病率降低31%,使冠状动脉的死亡率降低33%,总死亡率降低22%。治疗的目标是在患有CHD的患者中使用低密度脂蛋白(LDL)胆固醇,目标LDL <或= 100 mg / dL。在没有建立冠心病的高危患者中,低密度脂蛋白胆固醇的目标目标是<或= 130 mg / dL。非药物措施,胆汁酸螯合剂,烟酸和3-羟基-3-甲基戊二酰辅酶A(HMG-CoA)还原酶抑制剂均在降低胆固醇的治疗中起着重要作用。

  • 【磁共振成像在变性和炎性颞下颌关节疾病诊断中的功效:系统的文献综述。】 复制标题 收藏 收藏
    DOI:10.1016/j.tripleo.2006.02.001 复制DOI
    作者列表:Limchaichana N,Petersson A,Rohlin M
    BACKGROUND & AIMS: OBJECTIVE:To evaluate the evidence for the efficacy of magnetic resonance imaging (MRI) in the diagnosis of disk position and configuration, disk perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint. STUDY DESIGN:A PubMed literature search with specific indexing terms and a hand search were made. Two reviewers assessed the level of evidence of relevant publications as high, moderate, or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited, or insufficient. RESULTS:The literature search yielded 494 titles, of which 22 were relevant. No publication had a high level of evidence, and 12 had moderate and 10 low levels of evidence. The evidence grade for diagnostic efficacy expressed as sensitivity, specificity, and predictive values was insufficient. CONCLUSION:That evidence is insufficient emphasizes the need for high-quality studies on the diagnostic efficacy of MRI, incorporating accepted methodologic criteria.
    背景与目标: 目的:评估磁共振成像(MRI)在诊断椎间盘位置和结构,椎间盘穿孔,关节积液以及颞下颌关节骨和骨髓变化方面的有效性的证据。
    研究设计:进行了PubMed文献检索,包括特定的索引词和人工检索。两名审稿人对相关出版物的证据水平进行了评估,等级为高,中或低。基于此,诊断功效的证据等级被评为强,中度强,有限或不足。
    结果:文献检索产生494种图书,其中22种具有相关性。没有出版物具有高水平的证据,有12种具有中等水平的证据,有10种低水平的证据。以敏感性,特异性和预测值表示的诊断功效的证据等级不足。
    结论:证据不足,强调需要结合公认的方法学标准对MRI的诊断功效进行高质量的研究。
  • 【神经性厌食症和情感障碍的大脑葡萄糖代谢:体重减轻或抑郁症状的影响。】 复制标题 收藏 收藏
    DOI:10.1016/s0925-4927(97)02971-5 复制DOI
    作者列表:Delvenne V,Goldman S,De Maertelaer V,Wikler D,Damhaut P,Lotstra F
    BACKGROUND & AIMS: :Relationships between eating and affective disorders remain complex and unclear. Brain glucose metabolism of anorectic patients has been demonstrated to be reduced both globally and regionally, with a particular relative hypometabolism in the parietal cortex. To explore the possible influence of weight loss or depressive symptomatology on brain metabolism, we studied age- and sex-matched low-weight anorectic and depressed patients, normal-weight depressed patients, and healthy volunteers. Absolute global and regional glucose activity levels were reduced in low-weight patients, with the lowest values being found for anorectic patients. In relative values, anorectic patients showed a significant parietal hypometabolism in comparison to control subjects while they had higher metabolism in the caudate nuclei when compared with the other groups. Absolute hypometabolism of glucose seems to be a consequence of low weight as it was found in both low-weight anorectic and low-weight depressive patients. In addition, absolute glucose values were significantly correlated with body mass index in all subjects. Future positron emission tomographic studies in psychiatric patients should control for alimentary parameters.
    背景与目标: 饮食和情感障碍之间的关系仍然复杂且不清楚。厌食症患者的脑葡萄糖代谢已被证实在全球和区域均降低,顶叶皮层中存在特定的相对低代谢。为了探索减肥或抑郁症状对脑代谢的可能影响,我们研究了年龄和性别相匹配的低体重厌食症和抑郁症患者,正常体重的抑郁症患者以及健康志愿者。低体重患者的全球和区域绝对葡萄糖活性水平降低,而厌食患者的葡萄糖水平最低。在相对价值方面,与对照组相比,厌食患者的顶叶代谢明显降低,而尾核中的新陈代谢较其他组更高。葡萄糖的绝对低代谢似乎是低体重的结果,因为它在低体重厌食症患者和低体重抑郁症患者中均被发现。另外,在所有受试者中,绝对葡萄糖值与体重指数显着相关。未来精神病患者的正电子发射断层扫描研究应控制饮食参数。
  • 【结缔组织的遗传性疾病:审查。】 复制标题 收藏 收藏
    DOI:10.1046/j.1524-475X.1997.50105.x 复制DOI
    作者列表:Klett CC
    BACKGROUND & AIMS: :Extracellular matrix is a very complex assemblage of specialized molecules including collagen, elastin, proteoglycans, and attachment glycoproteins such as fibronectin and laminin. Collagen is an unusual protein because it requires multiple processing steps both within and outside the cell beginning with transcription and refinement of its messenger RNA, translation of the mature mRNA, extensive post-translational modifications, and further alterations in the extracellular compartments. If errors are made at any one of the multiple steps in this complex pathway, a defective molecule will be formed that could result in connective tissue abnormalities. Similarly, alterations in other components of the extracellular matrix can also result in clinical pathologies. Some of these clinical phenotypes have been classified as Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta, and epidermolysis bullosa. This article reviews these various connective tissue disorders, describes the underlying biochemical defects, and describes their impact on tissue repair.
    背景与目标: :细胞外基质是由特殊分子组成的非常复杂的集合体,包括胶原蛋白,弹性蛋白,蛋白聚糖和附着糖蛋白(如纤连蛋白和层粘连蛋白)。胶原蛋白是一种不寻常的蛋白质,因为它需要在细胞内外进行多个处理步骤,从其信使RNA的转录和精制,成熟mRNA的翻译,广泛的翻译后修饰以及细胞外区室的进一步改变开始。如果在此复杂路径的多个步骤中的任何一个步骤上出错,就会形成有缺陷的分子,从而可能导致结缔组织异常。类似地,细胞外基质其他成分的改变也可导致临床病理。这些临床表型中的一些已被分类为Ehlers-Danlos综合征,Marfan综合征,成骨不全症和大疱性表皮松解。本文回顾了这些各种结缔组织疾病,描述了潜在的生化缺陷,并描述了它们对组织修复的影响。
  • 【拼命寻找5-羟色胺...关于替加色罗的退出以及功能性和运动性疾病药物开发状况的评论。】 复制标题 收藏 收藏
    DOI:10.1053/j.gastro.2007.04.057 复制DOI
    作者列表:Pasricha PJ
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【对焦虑症的成人认知行为治疗结果进行荟萃分析。】 复制标题 收藏 收藏
    DOI:10.1097/01.nmd.0000253843.70149.9a 复制DOI
    作者列表:Norton PJ,Price EC
    BACKGROUND & AIMS: :The efficacy of cognitive behavioral treatments (CBT) for anxiety in adults has been supported by multiple meta-analyses. However, most have focused on only 1 diagnosis, thereby disallowing diagnostic comparisons. This study examined the efficacy of CBT across the anxiety disorders. One hundred eight trials of CBT for an anxiety disorder met study criteria. Cognitive therapy and exposure therapy alone, in combination, or combined with relaxation training, were efficacious across the anxiety disorders, with no differential efficacy for any treatment components for any specific diagnoses. However, when comparing across diagnoses, outcomes for generalized anxiety disorder and posttraumatic stress disorder were superior to those for social anxiety disorder, but no other differences emerged. CBT effects were superior to those for no-treatment and expectancy control treatments, although tentative evidence suggested equal effects of CBT when compared with relaxation-only treatments.
    背景与目标: :多种荟萃分析支持了认知行为治疗(CBT)对成人焦虑症的疗效。但是,大多数只集中于1个诊断,因此无法进行诊断比较。这项研究检查了CBT对焦虑症的疗效。 CBT治疗焦虑症的108项试验符合研究标准。单独的认知疗法和暴露疗法,或与放松训练相结合,在焦虑症中都是有效的,对于任何针对特定诊断的治疗成分,其疗效均无差异。然而,当比较各个诊断时,广义焦虑症和创伤后应激障碍的结局优于社交焦虑症的结局,但没有其他差异出现。尽管初步证据表明与仅放松疗法相比,CBT的效果相同,但CBT的效果优于未治疗和预期对照的效果。

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