Effects of SSRIs on peripheral inflammatory cytokines in patients with Generalized Anxiety Disorder.

BACKGROUND: Extensive research into psychoneuroimmunology has led to substantial advances in our understanding of the reciprocal interactions between the central nervous system and the immune system in neuropsychiatric disorders. To date, inflammation has been implicated in the pathogenesis of depression and anxiety. The immunomodulating effects of antidepressants on depression have been reported, however, there is no evidence of the similar effects of antidepressants on anxiety. The aim of the study was to investigate the effects of selective serotonin reuptake inhibitors (SSRIs) on peripheral inflammatory cytokines in patients with first episode generalized anxiety disorder (GAD). METHODS: A prospective cohort design was employed: 42 patients with first episode GAD were treated with either escitalopram or sertraline for 12 weeks. Anxiety was measured by the Generalized Anxiety Disorder Scale and the State Trait Anxiety Inventory, serum pro-inflammatory cytokine levels were measured by the enzyme-linked immunosorbent assay (ELISA), and CRP determined by an immunoturbidimetric method before and after SSRIs treatment RESULTS: Baseline levels of anxiety and pro-inflammatory cytokines including IL-1α, IL-6, IL-8, IL-12, IFN-γ, and CRP were significantly reduced after treatment of SSRIs (p < 0.05 in all cases). In addition, the change of anxiety measures co-vary with the change of peripheral cytokine levels (p < 0.05 in all cases). The regression model revealed that log transformed baseline levels of CRP and IL-6 predicted treatment response (p < 0.05 in both cases). CONCLUSIONS: This study is the first to investigate the effects of SSRIs on pro-inflammatory cytokines in patients with first episode GAD. The findings indicate moderate acute anti-inflammatory effects of SSRIs in GAD, and suggest that these anti-inflammatory effects may underlie anxiolytic effects of SSRIs. The study also indicates that serum levels of CRP and IL-6 may predict treatment response. However, data from randomized controlled trials is warranted to confirm these findings.

Iodine-131: An Effective Method for Treating Lymph Node Metastases of Differentiated Thyroid Cancer.

BACKGROUND The aim of this study was to assess the efficacy of radioactive iodine-131 (¹³¹I) therapy for lymph node metastasis of differentiated thyroid cancer (DTC) and to identify influential factors using univariate and multivariate analyses to determine if identified factors influence the efficacy of treatment. MATERIAL AND METHODS This study included a retrospective review of 218 patients with histologically proven DTC in the post-operation stage. After thyroid tissue remnants were eliminated with ¹³¹I therapy, patients' lymph node status was confirmed by ultrasound and by ¹³¹I whole body scan regarding lymph node metastasis, and then patients were treated with ¹³¹I as appropriate. The treatment efficacy was assessed and possible influencing factors were identified using univariate and multivariate analyses. RESULTS The total effective rate of ¹³¹I therapy was 88.07% (including a cure rate of 20.64% and an improvement rate of 67.43%). The non-effective rate was 11.93%. Of the total 406 lymph nodes of 218 patients, 319 lymph nodes (78.57%) were judged to be effectively cured, including 133 (32.75%) lymph nodes that were totally eliminated and 186 (45.82%) lymph nodes that shrank. Eighty-seven (21.43%) of the 406 lymph nodes had no obvious change. No lymph nodes were found to be in a continuously enlarging state. Distant metastasis, size of lymph node, human serum thyroglobulin (HTG) level, and condition of thyroid remnants ablation were identified as the independent factors influencing the efficacy of treatment using univariate and multivariate analyses. CONCLUSIONS The use of ¹³¹I is a promising treatment for lymph node metastasis of DCT. Distant metastasis, size of lymph nodes, HTG level, and condition of thyroid remnant ablation were independent factors influencing the treatment efficacy.

[TgAb interference with experimental Tg values detected by dilution curves].

OBJECTIVE: To identify the interference of endogenous antithyroglobulin (TgAb) with experimental thyroglobulin (Tg) values using dilution curves. METHODS: Dilution buffer, detectable TgAb serums (TgAb 20-25 IU/mL, Tg free) and undetectable TgAb serums (TgAb < 10 IU/mL, Tg free) were employed to dilute the Tg serums from patients with DTC, respectively. The Tg values were detected by immunometric assay (IMA). The experimental Tg values (Y-axis) were plotted against expected serum Tg values (X-axis). Diluted curves were used to evaluate the interference of TgAb on the experimental Tg values. A linear dilution curve is supposed to appear if no TgAb interference exists. RESULTS: The Tg dilution curves with dilution buffer were linear. Thirty six dilution curves were obtained with TgAb serums from six patients diluted by detectable TgAb serums, and 12 showed linear. Tg serums from six patients diluted by one detectable TgAb serum resulted in both linear and non-linear results. One Tg serum diluted by six TgAb serums also resulted both linear and non-linear results. Tg serums from three patients diluted by five undetectable TgAb serums resulted in 11 dilution curves, four of which were linear. CONCLUSION: Dilution curves can be used to predict TgAb interference indirectly. Detectable TgAb may not interfere with experimental Tg values. Whereas, undetectable TgAb may interfere with Tg values. TgAb could not be used to predict Tg interference.

[Influence of endogenous TgAb upon serum Tg measurement results and Tg positive rate in patients with differentiated thyroid carcinoma].

The first aim of this study was to compare the serum thyroglobulin (Tg) positive rate between differentiated thyroid carcinoma (DTC) patients with positive thyroglobulin antibody (TgAb) and patients with negative TgAb. The second aim of this study was to investigate the correlation between serum Tg value and antithyroglobulin (TgAb) concentration of patients with DTC. We collected the serum Tg value and TgAb concentration of patients with DTC after thyroid ablation by operation and radioiodine therapy retrospectively. Then we investigated the Tg positive rate of DTC patients with positive TgAb and patients with negative TgAb separately. The scatter diagram between serum Tg value and TgAb concentration of DTC patients was performed to analyze their potential relationship. As a result, among 252 patients with DTC after thyroid ablation, 7 of 47 patients (14.89%) with positive TgAb (>115 IU/mL) had positive serum Tg (>10 microg/L), and 61 of 205 (29.76%) patients with negative TgAb (<115 IU/mL) had positive serum Tg. Eighty three of the 252 patients with DTC had accurate serum Tg and TgAb concentration. No correlation between serum Tg value and TgAb concentration was found among these Eighty three patients. Thus, it may be concluded that positive TgAb could cause much more TgAb interference in serum Tg value than negative TgAb could because of a different quality of TgAb. Serum Tg value is not correlated with serum TgAb concentration in patients with DTC after thyroid ablation.

[Radioiodine labeled L-tyrosine SPECT scintigraphy in E. coli focus infection of mouse].

The aim of this study was to assess the role of 131 I-L-tyrosine for diagnosing E. coli infection and differentiating the infection from the inflammary lesion in mice. The L-tyrosine was labeled with 125 I by N-bromosuccinimide. The binding rates of 125 I-L-tyrosine with E. coli were tested by culturing E. coli with 125 I-L-tyrosine in poor nitrogen yeast medium and in rich nitrogen LB medium separately. The bio-distribution of 125 I-L-tyrosine and the 131 I-L-tyrosine SPECT scintigraphy in E. coli infection of mice were studied separately. The results revealed that the label rate of 125 I-L-tyrosine was more than 99%. The percentage of 125 I-L-tyrosine binding with E. coli was 2.78% in yeast medium, and was 0.85% in LB medium. The distribution peak of 125 I-L-tyrosine in E. coli focal infection of mice was in the range between 45 and 60 min. The infection/normal muscle ratio was 2.46 after 60 minutes. The SPECT scintigraphy demonstrated an accumulation of the 131 I-L-tyrosine in the E. coli focal infection during the 45-60 minutes. The infection/normal muscle ratio of the 131 I-L-tyrosine radioactivity was 2.51 in infectious mouse. However, the SPECT scintigraphy also demonstrated an accumulation of the 131 I-L-tyrosine in the inflammatory lesion during the 45-60 minutes. The lesion/normal muscle ratio of the 131 I-L-tyrosine radioactivity was 2.29 in inflammatory mouse at 60 mins. Thus, the 131 I-L-tyrosine SPECT scintigraphy could diagnose the E. coli infection, but it can not be used for differentiating the bacteria infection and the inflammatory lesion in mice. Our study revealed that the 131 I-L-tyrosine would play a potential role in diagnosing the inflammatory lesion in human beings.

Are fetal gender and gestational age related to the size of cisterna magna?

OBJECTIVES: The purpose of this article was to explore whether the gestational age(GA)and gender could affect the size of the cisterna magna (CM). METHODS: This study that included pregnant women who were between 20 ∼ 39+6. The recorded included BPD, HC, anteroposterior diameter of CM and gender. The fetuses were divided into normal and isolated enlargement of the CM (IECM)group for statistical analysis. RESULTS: Seven hundred ninety six fetuses with normal CM, 412 cases were boys and 384 cases were girls. 73 fetuses with IECM, 59 cases were boys and 14 cases were girls. The anteroposterior diameter of the CM increased with GA during 20-26+6 weeks. After 27 weeks, the anteroposterior diameter of CM became stable. In the IECM group, the mean anteroposterior of male and female fetuses were 1.31 ± 0.18 cm and 1.24 ± 0.15 cm, respectively. The IECM fetus accounted for 8.4% of the total number of fetuses, male IECM accounted for 14.3% of normal male fetus, and female fetus was 3.6%, which showed that male fetus had a higher rate of IECM than female (χ2 = 21.6, p<.001). CONCLUSIONS: There is a gender difference between normal fetuses and IECM fetuses. Based on our finding, it is reasonable to establish the normal value of CM according to the gender difference.

[The correlation between endogenous TgAb and experimental Tg values in patients with differentiated thyroid carcinomas].

OBJECTIVE: To determine the interference of antithyroglobulin (TgAb) on the measurement of serum thyroglobulin (Tg) in patients with differentiated thyroid carcinomas (DTC). METHODS: The Tg positive serum and TgAb positive serum were taken from the patients with total thyroidectomy and thyroid remnant ablation by radioiodine. The Tg positive serum contained high level of Tg (>10 microg/L) and nondetectable TgAb. The TgAb positive serum contained high level of TgAb (>115 IU/mL) and nondetectable Tg. We incubated a constant amount of Tg with increasing volumes of Tg-free autoantibodies and allowed them to equilibrate at room temperature for 12 hours before measuring Tg and TgAb. The thyroglobulin and TgAb values were determined by the Roche electrode induce chemiluminescent emission system with monoclonal antibody sandwich analysis. The correlation between TgAb and serum Tg values was analysed. RESULTS: TgAb led to underestimation of serum Tg values by 15%-50% in 8 patients with DTC. TgAb was correlated with the magnitude of underestimated serum Tg values in 3 patients with DTC, but not in the other 5 patients with DTC. CONCLUSION: TgAb underestimated serum Tg values in a dose-dependent manner in some patients with DTC, but not in others.

Effect of head circumference in combination with facial profile line on ultrasonic diagnosis of microcephaly.

Objective: Recently, microcephaly has usually been misdiagnosed only by ultrasound via measurement of head circumference (HC). Therefore, the aim of this study is to find another diagnostic index to supplement the original diagnostic method of microcephaly, to improve the detection rate of fetal microcephaly and to reduce the misdiagnosis rate.Methods: We retrospectively analyzed 123 pregnant women from February 2012 to January 2017 with fetal HC less than two standard deviations (SD). The facial profile line (FPL) was determined by ultrasonography. The first method (M1) was only used HC to determine whether the fetus was microcephaly, the second one (M2) was to combine HC and FPL for the diagnosis of microcephaly. Results were classified into five orderly categories by experienced sonographers. ROC curve was drawn to evaluate the diagnostic effect.Results: Among the pregnant women, 14 cases of fetal head circumference were less than 3SD, 109 were -2SD < HC≤ -3SD. A total of 12 cases were confirmed of microcephaly by magnetic resonance imaging (MRI) or postnatal, 10 cases of HC were less than 3SD, 2 were -2SD < HC≤ -3SD. The area under the ROC curve for M1 and M2 were 0.751 and 0.983 respectively.Conclusion: The HC in combination with FPL can be used to evaluate the fetal HC and forehead development quickly, and to improve the sensitivity and specificity of diagnosing fetal microcephaly.

Comparison of traditional 2D and 3D Omniview technique in detection of fetus corpus callosum.

AIM: To explore the value of Omniview (OV) technology in assessing the fetus corpus callosum. MATERIAL AND METHODS: For the ultrasound examination of 189 fetuses (gestational week range 19-28 weeks), two-dimensional (2D) ultrasound imaging and Omniview technology were used by two physicians (A and B). The acquisition time and the quality of images were recorded. RESULTS: The acquisition time of Omniview technology was shorter comparing with the aquisition time of 2D ultrasound imaging (A2D vs. AOV: 159.44±27.09 s vs. 73.90±18.99 s, p<0.01; B2D vs. BOV: 120.22±21.89 s vs. 74.19±14.86 seconds, p<0.01). 2D ultrasound examination was performed in a longer time by the junior physician, compared with the senior physician (A2D vs. B2D: 159.44±27.09 s vs. 120.22±21.89 s, p<0.01). The intra- and inter-observer reliability of acquisition time using Omniviewtechnology was good (LoA: ‒11.8 to +12.4s, and ‒41.9 to +43.3s, respectively). The success rate of junior and senior physicians with the Omniview technique was 76.2% and 80.4%, respectively. There was good consistency between the Omniview technique and 2D ultrasound imaging in terms of image quality (Kappa = 0.782, 95% CI: 0.586-0.977). CONCLUSION: Omniview technique can not only obtain corpus callosum images more effectively but also can achieve better quality images. Therefore, it is a reliable method to image the fetal corpus callosum.

Peripheral proinflammatory cytokines in Chinese patients with generalised anxiety disorder.

BACKGROUND: Inflammatory responses and inflammatory cytokines have been implicated in the pathogenesis of affective disorders, particularly major depression. Given the limited evidence relating to the potential role of proinflammatory cytokines in generalised anxiety disorder (GAD), we aimed to examine peripheral proinflammatory cytokines in Chinese patients with GAD. METHODS: A case-controlled cross-sectional study design, with recruitment of 48 patients with first episode GAD and 48 matched healthy controls. All participants completed measures of anxiety using well-established questionnaires, and serum levels of pro-inflammatory cytokines were measured using multiplex technology. RESULTS: Serum levels of CRP, IL-1α, IL-2, IL-6, IL-8, IL-12, IFN-γ, and GM-CSF were significantly higher in the GAD group in comparison to the control group (p < 0.05). Pearson correlation revealed significant positive correlations between anxiety measures and serum levels of CRP, IL-1α, IL-6, IL-8, IFN-γ, and GM-CSF (p < 0.05). LIMITATIONS: The cross-sectional study design does not permit definite conclusions on causal directions between inflammation and GAD. The study was limited to a panel of 8 cytokines and does not exclude the possibility of other important cytokines being involved. CONCLUSIONS: These findings indicate an elevated peripheral proinflammatory response, and provide further support for low grade inflammation in GAD. Further research may identify an 'inflammatory signature' for diagnosis and treatment response, and guide the search for novel pharmacological interventions.

[Comparison of the radioiodine thyroid uptake of diagnostic dose and therapeutic dose in patients with hyperthyroidism].

OBJECTIVE: To compare early kinetics of diagnostic dose 131I with that of therapeutic dose. METHODS: Thyroid Uptake Ratio (TUO) measurements of diagnose method on SPECT in 108 patients after oral administration 131I. RESULTS: The TUO of diagnostic dose was similar to that of therapeutic dose at 24 hours after the patients had take 131I (P > 0.05). CONCLUSION: Radioiodine thyroid uptake of diagnostic dose is consistent with that of therapeutic dose at 24 hours after oral administration of 131I.

[The primary applications of ¹5³Sm-EDTMP plus chemotherapy in the treatment of bone metastasis of lung cancer].

BACKGROUND: To study the clinical effects of ¹5³Sm-EDTMP plus chemotherapy in the treatment of bone metastasis of lung cancer. METHODS: One hundred and ten lung cancer patients with one metastasis [male 82 and female 28, aged from 32 to 76 yrs; squamous cell carcinoma 28, adenocarcinoma 27, small cell lung cancer (SCLC) 7, mix type 41, alveolar carcinoma 7] who did not undergo an operation were entered into this study. The patients were divided into 3 groups: ¹5³Sm-EDTMP therapy only (37 cases), ¹5³Sm-EDTMP plus chemotherapy after 3 days (42 cases), 30 days after chemotherapy plus ¹5³Sm-EDTMP (31 cases). The dosages of ¹5³Sm-EDTMP ranged from 1 111 to 2 660 MBq. The patients with SCLC were adapted CCNU, MTX and CTX; those with non-small cell lung cancer (NSCLC) were adapted MMC, VCR and DDP. Statistic analysis of the data was performed by Chi-square test. RESULTS: Total pain relief rate for ¹5³Sm-EDTMP only was 89.2% , for ¹5³Sm-EDTMP plus chemotherapy was 92.8%, and for chemotherapy plus 153 Sm EDTMP was 90.3% . The foci disappeared in 9 cases with ¹5³Sm-EDTMP only, in 12 cases with ¹5³Sm-EDTMP plus chemotherapy, and in 9 cases with chemotherapy plus ¹5³Sm-EDTMP. The 1 year survival rate was 29.7%(11/37) by 153 Sm only, 40.5%(17/42) by 153 Sm plus chemotherapy, 38.7%(12/31) by chemotherapy plus ¹5³Sm-EDTMP. CONCLUSIONS: ¹5³Sm-EDTMP plus chemotherapy is effective in the treatment of bone metastasis of lung cancer.

Elephantiasic pretibial myxedema in a patient with graves disease that resolved after 131I treatment.

Pretibial myxedema is a rare manifestation of Graves disease and is generally associated with ophthalmopathy. Steroids, immunoglobulin, or rituximab can have some therapeutic effect but not curative. Here we reported a 45-year-old man with history of hyperthyroidism for 20 years who developed severe bilateral pretibial myxedema. Three months after the treatment with I for his Graves disease, his pretibial myxedema was significantly improved.