作者机构：
[Yuan, Ning; Liu, Chunyu] Cent South Univ, Xiangya Hosp 2, Dept Psychiat, Changsha, Hunan, Peoples R China.;[Yuan, Ning; Liu, Chunyu] Cent South Univ, Xiangya Hosp 2, Mental Hlth Inst, Changsha, Hunan, Peoples R China.;[Yuan, Ning; Liu, Chunyu] Cent South Univ, Natl Clin Res Ctr Mental Disorders, Changsha, Hunan, Peoples R China.;[Yuan, Ning; Liu, Chunyu] Cent South Univ, Natl Technol Inst Mental Disorders, Changsha, Hunan, Peoples R China.;[Yuan, Ning; Liu, Chunyu] Hunan Univ Chinese Med, Sch Clin Med, Hunan Prov Brain Hosp, Dept Psychiat, Changsha, Hunan, Peoples R China.
通讯机构：
[Liu, Chunyu] C;[Liu, Chunyu] H;Cent South Univ, Xiangya Hosp 2, Dept Psychiat, Changsha, Hunan, Peoples R China.;Cent South Univ, Xiangya Hosp 2, Mental Hlth Inst, Changsha, Hunan, Peoples R China.;Cent South Univ, Natl Clin Res Ctr Mental Disorders, Changsha, Hunan, Peoples R China.
摘要：
Inflammation is a natural defence response of the immune system against environmental insult, stress and injury, but hyper- and hypo-inflammatory responses can trigger diseases. Accumulating evidence suggests that inflammation is involved in multiple psychiatric disorders. Using inflammation-related factors as biomarkers of psychiatric disorders requires the proof of reproducibility and specificity of the changes in different disorders, which remains to be established. We performed a cross-disorder study by systematically evaluating the meta-analysis results of inflammation-related factors in eight major psychiatric disorders, including schizophrenia (SCZ), bipolar disorder (BD), autism spectrum disorder (ASD), major depression disorder (MDD), post-trauma stress disorder (PTSD), sleeping disorder (SD), obsessive-compulsive disorder (OCD) and suicide. A total of 43 meta-analyses involving 704 publications on 44 inflammation-related factors were included in the study. We calculated the effect size and statistical power for every inflammation-related factor in each disorder. Our analyses showed that well-powered case-control studies provided more consistent results than underpowered studies when one factor was meta-analysed by different researchers. After removing underpowered studies, 30 of the 44 inflammation-related factors showed significant alterations in at least one disorder based on well-powered meta-analyses. Eleven of them changed in patients of more than two disorders when compared with the controls. A few inflammation-related factors showed unique changes in specific disorders (e.g., IL-4 increased in BD, decreased in suicide, but had no change in MDD, ASD, PTSD and SCZ). MDD had the largest number of changes while SD has the least. Clustering analysis showed that closely related disorders share similar patterns of inflammatory changes, as genome-wide genetic studies have found. According to the effect size obtained from the meta-analyses, 13 inflammation-related factors would need <50 cases and 50 controls to achieve 80% power to show significant differences (p < 0.0016) between patients and controls. Changes in different states of MDD, SCZ or BD were also observed in various comparisons. Studies comparing first-episode SCZ to controls may have more reproducible findings than those comparing pre- and post-treatment results. Longitudinal, system-wide studies of inflammation regulation that can differentiate trait- and state-specific changes will be needed to establish valuable biomarkers.
摘要：
Neurons undergo degeneration, apoptosis and death due to ischaemic stroke. The present study investigated the effect of Sijunzi decoction (SJZD), a type of traditional Chinese medicine known as invigorating spleen therapy, on anoikis (a type of apoptosis) in rat brains following cerebral ischaemia-reperfusion. Rats were randomly divided into sham, model, nimodipine and SJZD low/medium/high dose groups. A middle cerebral artery occlusion model was established. Neurobehavioural scores were evaluated after administration for 14 days using a five-grade scale. Blood-brain barrier permeability and apoptotic rate were detected using Evans blue (EB) extravasation and TUNEL staining, respectively. Tissue inhibitor of metalloproteinase 1 (TIMP-1), matrix metalloproteinase 9 (MMP-9) and collagen IV (COL IV) were determined using immunohistochemistry. Neurobehavioural scores decreased remarkably in all SJZD and nimodipine groups compared to the model group (P<0.05). Compared with the sham group, EB extravasation was higher in the model group (P<0.01). The amount of EB extravasation decreased in the SJZD high dose and nimodipine groups compared to the model group (P<0.01), and extravasation in the SJZD high dose group was lower than the SJZD low and medium dose groups (P<0.01). TIMP-1 and MMP-9 expression and apoptotic rate increased, but COL IV decreased significantly in the hippocampus of the model group compared to the sham group (P<0.01). TIMP-1 and COL IV expression increased significantly and MMP-9 and apoptotic rate decreased remarkably in all SJZD and nimodipine groups compared to the model group (P<0.01). TIMP-1 and COL IV expression decreased, but MMP-9 expression and apoptotic rate increased in the SJZD low and medium dose groups compared to the SJZD high dose group (P<0.01). SJZD rescued neurons and improved neurobehavioural function in rats following cerebral ischaemia-reperfusion, especially when used at a high dose. The mechanism may be related to protection of the extracellular matrix followed by anti-apoptotic effects.
摘要：
The main clinical manifestations of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis are acute or subacute seizures, cognition impairment, and psychiatric symptoms. Nowadays, the scheme of antipsychotic therapy for this disease has not been established. This study reports three cases of anti-NMDAR encephalitis with psychiatric symptoms. The anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum were positive. The psychiatric symptoms still existed after intravenous immunoglobulin (IVIG) treatment; thus, clozapine was used for antipsychotic therapy. Case 1 was a 37-year-old man who suffered from bad mood and suicide behaviors for 1 month. Hallucination and delusion still existed after IVIG treatment and hormone therapy, and the symptoms were relieved when given clozapine for 12 months. Case 2 was a 28-year-old man who was admitted to our hospital due to injuring other people and destructive behaviors for 2 days. He showed irritability, bad temper, declined cognition, and severe delusion of persecution after IVIG treatment and hormone therapy, but the psychiatric symptoms disappeared when given clozapine for 3 months. Case 3 was a 23-year-old man who suffered from headache and babbing for 7 days. Symptoms such as irritability, bad temper, babbing, and injuring other people still existed after IVIG treatment and hormone therapy, but they disappeared when given clozapine for 2 months. Therefore, we suggest that during the treatment of anti-NMDAR encephalitis with psychiatric symptoms, if the anti-NMDAR antibodies in CSF and serum were positive, and psychiatric symptoms could not be controlled after IVIG and hormone therapy, clozapine may work.
摘要：
Abstract: Objective: To investigate the clinical efficacy of bridging therapy for acute cardiogenic cerebral infarction, and to evaluate its safety and efficacy. Methods: To select 16 cases of patients with acute cardiogenic cerebral infarction from January 1, 2016 to January 1, 2018. All of the patients in the time window are given the recombinant tissue plasminogen activator (rt-PA) for intravenous thrombolysis (total dosage is 0.9 mg/Kg; 10% of them were intravenous injection, the remaining were continuous intravenous drip in 60 minutes). Then, the mechanical thrombectomy was performed under general anesthesia. Modified Thrombolysis in Cerebral Infarction (mTICI) was used to assess vascular recanalization, and the grade 2b/3 of it was used as the success criteria for endovascular treatment of acute cardiogenic cerebral infarction. The occlusion site and general in-formation (such as age and gender) of all patients were recorded. The National Institute of Health stroke scale score (NIHSS) was recorded before and 24 hours after treatment. Patients were fol-lowed up by telephone or outpatient service 3 months after surgery, and the modified Rinkin Scale score (mRS) after 90 days was recorded to evaluate the prognosis, and the rate of good prognosis (mRS 0 - 2 points) was recorded. Results: 16 patients were diagnosed as acute cardiogenic cerebral infarction, of which 10 were males and 6 were females, aged 49 - 70 years old, with the average age (60.81 ± 6.28 years old). Preoperative NIHSS score (17.19 ± 3.43), and postoperative NIHSS score (11.88 ± 3.61) were obtained. Among them, 14 cases were middle cerebral artery occlusion, 2 cases were basilar artery occlusion, and 16 cases were recanalization (TICI 2b). Twelve patients were graded 0~2 mRS score. The three-month mortality rate was 12.5%. Conclusion: The study shows that rt-PA combined with mechanical thrombolysis can improve the patients’ vascular recanalization rate and significantly improve the short-term neurological function and long-term prognosis of acute cardiogenic cerebral embolism, but it needs further exploration in a larger sample.#@#@#摘要: 目的：本研究旨在探讨静脉溶栓桥接动脉机械碎栓、取栓术治疗急性心源性脑梗塞的临床疗效，评估桥接治疗急性心源性脑栓塞的安全性及有效性。方法：选取我院2016年1月1日至2018年1月1日收入院的16例急性心源性脑栓塞患者，所有患者在静脉溶栓时间窗内给予重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator, rt-PA)静脉溶栓治疗(剂量为0.9 mg/Kg，先予以10%的剂量静脉推注，剩余的90%持续静脉滴注，共60分钟)，之后在全麻下行动脉内机械碎栓、取栓术，通过改良脑梗死溶栓血流分级(modified Thrombolysis In Cerebral Infarction, mTICI)评估血管再通情况，将mTICI分级2b/3级作为急性心源性脑栓塞血管内治疗成功标准。记录所有患者血管闭塞的部位，患者的一般资料(如年龄、性别)。记录患者治疗前、治疗24小时后的美国国立卫生研究院卒中量表(National Institute of Health stroke scale, NIHSS)评分；术后3个月电话或门诊随访患者，记录患者90天后改良Rankin量表(modified Rinkin Scale, mRS)评分来评估预后，记录预后良好率(mRS 0~2分)。结果：16例诊断为急性心源性脑栓塞的患者，男10例，女6例，年龄49~70岁，平均年龄(60.81 ± 6.28，岁)。术前NIHSS评分(17.19 ± 3.43)分，术后24 h NIHSS评分(11.88 ± 3.61)，其中14例为大脑中动脉闭塞，2例为基底动脉闭塞，16例患者术后血管均再通(TICI ≥ 2 b)；其中mRS评分0~2级12例。3个月内死亡率为12.5%。结论：本研究表明rt-PA静脉溶栓联合机械取栓可提高患者血管再通率，可显著改善急性心源性脑栓塞的短期神经功能和远期预后的方法，但尚需更大样本的研究进一步探索。
