Therapeutic Reactance as a Predictor of Outcome in the Treatment of Chronic Depression.

This study examined whether reactance would negatively influence treatment outcome in 347 patients diagnosed with chronic forms of depression and treated at 9 sites with either Nefazodone, cognitive-behavioral analysis system of psychotherapy (CBASP), or combination therapy. Contrary to our hypotheses, reactance positively predicted treatment outcome in CBASP on 2 of 4 scales. These effects were independent of the therapeutic alliance, which also positively predicted outcome. Reactance did not predict outcome in the groups receiving medication alone or in combination with CBASP. The findings suggest that reactance may be an asset in psychotherapy among chronically depressed individuals and that reactant patients can benefit from directive psychotherapy when therapists flexibly respond to perturbations in the therapeutic relationship. Results support the importance of Aptitude × Treatment interactions in psychotherapy outcome. The direction and significance of such interactions may vary with different forms of psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression in Multiple Sclerosis: A Quantitative Review of the Evidence.

The published literature on depression in multiple sclerosis (MS) is reviewed quantitatively. The authors report mean effect sizes for 20 studies comparing depression scores of MS patients with those of healthy participants (d=1.07) and 21 studies comparing depression scores of MS patients with those of patients who have other chronic conditions (d=-0.14). The confidence interval for the mean overall MS-medical comparison included 0. However, subgroups of patients with chronic fatigue and spinal-neuromuscular conditions were more and less depressed than MS patients, respectively. Results indicate that a majority of MS patients with mild to moderate disability levels are distinguishable from healthy people in terms of depressive symptoms. However, the depression-disease link is complex and not specific to this form of demyelinating illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

慢性酒精中毒性疾病与泛素-蛋白酶体途径异常调节的研究简

泛素-蛋白酶体途径是细胞内蛋白质降解的主要途径,在多种细胞生命过程中发挥重要作用。目前研究证实慢性酒精中毒可导致泛素-蛋白酶体途径异常调节,主要涉及蛋白酶体活性、泛素分子合成以及相关蛋白分子表达改变等,并且与一些慢性酒精中毒性疾病的发生有关,包括酒精中毒性肝病、酒精中毒性脑病和酒精中毒性肌病。这些发现为进一步揭示酒精诱导损伤的分子机制以及研发治疗慢性酒精中毒性疾病的新型药物提供了重要的研究方向。     

氯沙坦对老年慢性充血性心力衰竭患者血浆 NT-proBNP 水平的影响简

目的：探讨氯沙坦对老年慢性充血性心力衰竭（CHF）患者血浆 N 端脑钠肽前体（NT-proBNP）水平的影响。方法将60例慢性CHF患者按入院的先后顺序分为2组：观察组和对照组,每组30例。2组均采用常规治疗,包括抗心力衰竭药物、强心药和利尿剂等治疗。在此基础上,观察组研究前1周停止使用血管扩张药,采用氯沙坦治疗。使用免疫定量分析仪、采用胶体金法测定2组血浆 NT-proBNP水平。观察2组治疗前、治疗8周后的血压（SBP、DBP）、心率（HR）、心胸比、NYHA分级（NYHAⅡ级、Ⅲ级和Ⅳ级）和血浆 NT-proBNP 水平的变化情况。结果观察组治疗8周后SBP、DBP、HR、心胸比和血浆NT-proBNP水平均较对照组有所降低（均P＜0．05）, NYHAⅡ级、Ⅲ级和Ⅳ级均较治疗前、对照组明显改善（P＜0．05或P＜0．01）;对照组治疗8周后 NYHAⅡ级、Ⅲ级和Ⅳ级均较治疗前无明显改善（均P＞0．05）。结论 NT-proBNP水平可指导慢性 CHF患者药物治疗,且氯沙坦能有效地改善老年慢性CHF患者的心功能,值得临床应用。     

Effect of hemodiafiltration with endogenous reinfusion on overt idiopathic chronic inflammation in maintenance hemodialysis patients: A multicenter longitudinal study

Chronic inflammation is widely diffuse in maintenance hemodialysis (MHD) patients and is associated with poor survival. Hemodiafiltration with endogenous reinfusion (HFR) is a dialysis technique, highly biocompatible, able to adsorb proinflammatory cytokines and to decrease amino acids and antioxidants loss. These features could be helpful in MHD patients affected by idiopathic chronic inflammation, but this issue remains to be elucidated. We performed a multicenter longitudinal study to assess the effect of the switching from bicarbonate HD to HFR in patients with serum C‐reactive Protein (CRP) > 5 mg/L coupled with albumin <4.0 g/dL in the last 6 months. We enrolled 24/176 (14%) patients, of which 20 patients were assessed at 4 months and 18 completed the study. We excluded 11 patients with evident causes of inflammation. At baseline, serum levels of CRP (18.7[7.0–39.4] mg/L) and albumin (3.5[3.3–3.7] g/dL) were significantly correlated (r = ?0.49; P = 0.028). The effect on CRP and albumin was almost evident in the first 4 months and remained stable until to eighth month. A strict correlation (R = ?0.49; 0.040) between percentage change of CRP (?35%) and albumin (+14%) after 8 months of HFR. These effects were associated with the reduction of IL‐6, IL‐1β, and TNF‐α and the increment of pre‐albumin and leptin, whereas the serum levels of Branched Chain Amino Acid (BCAA) remained unchanged. In MHD patients affected by idiopathic chronic inflammation the switching from BHD to HFR is associated with improvement of inflammation. Whether these favorable effects may modify the outcomes of these high‐risk patients needs to be confirmed by studies ad hoc.     

基于马尔科夫决策过程的慢性非传染性疾病体检策略的优化

以2型糖尿病为例,探讨慢性非传染性疾病体检策略优化的问题。以最大化体检效用为目标,建立马尔科夫决策模型。模型从全社会角度定义成本的评价函数,除考虑直接医疗成本外,还考虑了间接的非医疗成本。为了使模型具有更大的现实意义,模型还考虑了患者由于及时体检知晓病情后生活习惯改善这一因素。采用逆向归纳法求解,结果证明模型能有效优化体检周期。通过对比,证明改进的成本评价函数和生活习惯改善这两个因素确实对优化结果有显著影响。     

Personalized Healthcare System for Chronic Disease Care in Cloud Environment

The rapid increase in the number of patients with chronic diseases is an important public healthcare issue in many countries, which accelerates many studies on a healthcare system that can, whenever and wherever, extract and process patient data. A patient with a chronic disease conducts self‐management in an out‐of‐hospital environment, particularly in an at‐home environment, so it is important to provide integrated and personalized healthcare services for effective care. To help provide effective care for chronic disease patients, we propose a service flow and a new cloud‐based personalized healthcare system architecture supporting both at‐home and at‐hospital environments. The system considers the different characteristics of at‐hospital and at‐home environments, and it provides various chronic disease care services. A prototype implementation and a predicted cost model are provided to show the effectiveness of the system. The proposed personalized healthcare system can support cost‐effective disease care in an at‐hospital environment and personalized self‐management of chronic disease in an at‐home environment.     

生酮饮食对部分慢性疾病的作用机制研究进展

生酮饮食(Ketogenic diet,KD)是指一种高脂肪、低碳水化合物、适量蛋白质的饮食方式。生酮饮食作为难治性癫痫(Refractory epilepsy,RE)疾病的非药物治疗方法之一,已有近百年的应用历史。随着经典生酮饮食(Classic ketogenic diet,CKD)到中链甘油三酯饮食(Medium chain triglyceride diet,MCT)、改良阿特金斯饮食(Modified Atkins diet,MAD)、低血糖指数饮食(Low glycemic index treatment,LGIT)的演变,生酮饮食已不局限于治疗儿童难治性癫痫等常见神经系统疾病。最新研究发现,生酮饮食疗法在糖尿病及其并发症、肥胖症及相关疾病、肿瘤等慢性疾病的防控方面发挥潜在作用。本文综述了生酮饮食及其在慢性疾病改善方面的应用情况、可能的作用机制及其应用安全性,以期为KD进一步应用和推广提供论据。     

Brown Adipose Tissue,Batokines, and Bioactive Compounds in Foods: An Update

The discovery of metabolically active brown adipose tissue (BAT) in human adults and the worldwide increase in obesity and obesity-related chronic noncommunicable diseases (NCDs) has made BAT a therapeutic target in the last two decades. The potential of BAT to oxidize fatty acids rapidly and increase energy expenditure inversely correlates with adiposity, insulin and glucose resistance, and cardiovascular and metabolic diseases. Currently, BAT is recognized by a new molecular signature; several BAT-derived molecules that act positively on target tissues have been identified and collectively called batokines. Bioactive compounds present in foods are endowed with thermogenic properties that increase BAT activation signaling. Understanding the mechanisms that lead to BAT activation and the batokines secreted by it within the thermogenic state is fundamental for its recruitment and management of obesity and NCDs. This review contributes to recent updates on the morphophysiology of BAT, its endocrine role in obesity, and the main bioactive compounds present in foods involved in classical and nonclassical thermogenic pathways activation.     

CCL4 Regulates Eosinophil Activation in Eosinophilic Airway Inflammation

Eosinophilic chronic rhinosinusitis (ECRS) is a refractory airway disease accompanied by eosinophilic inflammation, the mechanisms of which are unknown. We recently found that CCL4/MIP-1β—a specific ligand for CCR5 receptors—was implicated in eosinophil recruitment into the inflammatory site and was substantially released from activated eosinophils. Moreover, it was found in nasal polyps from patients with ECRS, primarily in epithelial cells. In the present study, the role of epithelial cell-derived CCL4 in eosinophil activation was investigated. First, CCL4 expression in nasal polyps from patients with ECRS as well as its role of CCL4 in eosinophilic airway inflammation were investigated in an in vivo model. Furthermore, the role of CCL4 in CD69 expression—a marker of activated eosinophils—as well as the signaling pathways involved in CCL4-mediated eosinophil activation were investigated. Notably, CCL4 expression, but not CCL5, CCL11, or CCL26, was found to be significantly increased in nasal polyps from patients with ECRS associated with eosinophil infiltration as well as in BEAS-2B cells co-incubated with eosinophils. In an OVA-induced allergic mouse model, CCL4 increased eosinophil accumulation in the nasal mucosa and the bronchoalveolar lavage (BALF). Moreover, we found that CD69 expression was upregulated in CCL4-stimulated eosinophils; similarly, phosphorylation of several kinases, including platelet-derived growth factor receptor (PDGFR)β, SRC kinase family (Lck, Src, and Yes), and extracellular signal-regulated kinase (ERK), was upregulated. Further, CCR5, PDGFRβ, and/or Src kinase inhibition partially restored CCL4-induced CD69 upregulation. Thus, CCL4, which is derived from airway epithelial cells, plays a role in the accumulation and activation of eosinophils at inflammatory sites. These findings may provide a novel therapeutic target for eosinophilic airway inflammation, such as ECRS.