Volume 99 ·  Issue 11 ·  2019

To explore the clinical characteristics and short-term prognosis of Holmes′ tremor (HT) patients.

The clinical and imaging data of HT patients in 5 teaching hospitals between January 2014 and January 2018 were retrospectively analyzed, and Fahn-Tolosa-Marin Tremor Rating Scale (TRS) was used to compare the clinical severity and short-term prognosis between the different subtypes.

(1) The time from primary disease to tremor onset was 2 days to 20 months (median time 29 d) in 23 patients with HT enrolled, and the most common cause of HT was cerebrovascular disease (78.3%). (2) The most common involved locations were midbrain (65.2%), thalamus (47.8%) and cerebellum (30.4%). No significant difference in total TRS scores between the isolated lesion group (12 cases) and multiple lesions group (11 cases) (P=0.57), while the scores of the mesencephalic group (15 cases) was significantly higher than the non-mesencephalic group (8 cases) (P=0.00). (3) One case was treated with deep brain stimulation (DBS), while 22 cases were treated with medical therapy. Levodopa combined with clonazepam (7/12) and single levodopa (9/20) were partially effective. (4) At the 3-month follow-up after discharge, patients received DBS had good prognosis. Among the 22 patients treated with medicine, only 8 (36.4%) patients had good outcomes. The short-term prognosis was not significantly different between the isolated and multiple lesion groups (P=0.40), while it was worse in the mesencephalic group than the non-mesencephalic group (P=0.02).

The most common cause of HT is cerebrovascular disease, and primary lesions are midbrain, thalamus, and cerebellum. The pharmacologic agents are partially valid for disease control of HT and the short-term prognosis is poor, while the patients with mesencephalic involvement have more severe tremor and worse prognosis.

To study the clinical symptoms, copper metabolism and imaging characteristics of Wilson disease (WD) carriers and to explore the treatment strategy of WD carriers.

Forty WD carriers, 40 WD patients and 20 normal controls from the First Affiliated Hospital of Sun Yat-sen University from July 2007 to May 2018 were included. The modified Young scale was used for neural symptom scoring, and Child grading of liver function, mental symptoms rating scale, magnetic resonance imaging (MRI) scan, susceptibility weighted imaging (SWI) inspection, metal metabolism tests were also applied to all the included subjects. Corrected phase (CP) was measured by SWI. WD carriers were divided into symptomatic group and asymptomatic group. Symptomatic WD carriers were treated with penicillamine for 2 weeks and zinc gluconate for 3 months, then their neurological symptoms, liver function grade, metal metabolism index were rechecked.

Six WD carriers presented with some clinical symptoms, including 5 with neurological symptoms and 4 with liver dysfunction. The score of Hamilton anxiety (HAMA) scale of symptomatic WD carriers was higher than that of normal control group (P=0.021). 85% of carriers had ceruloplasmin level less than 0.26 g/L. 80% of carriers had serum copper between normal controls and WD patients. The free copper level of WD carriers was lower than that of WD patients (P=0.012, 0.019). Urinary copper in symptomatic WD carriers was higher than normal controls (P=0.047). The CP values of thalamus, globus pallidus and putamen in symptomatic WD carriers were lower than those in normal control group. After treatment with penicillamine in symptomatic WD carriers, urinary copper was higher than that before treatment (P=0.036). After treatment, the liver enzymes of symptomatic WD carriers returned to normal, and the score of modified Young scale was lower than before treatment (P=0.031).

Mild copper metabolism abnormality is seen in WD carriers. A few carriers have neurological symptoms such as limb tremors, or liver symptoms such as abnormal liver enzymes. Abnormal copper metabolism is more serious in symptomatic WD carriers than in asymptomatic WD carriers. Symptomatic WD carriers can be treated with zinc gluconate.

The aim of the study was to determine whether there was gender difference in clinical manifestations and comorbidities in the patients with Spondyloarthritis (SpA) in China.

346 patients fulfilling ASAS criteria for SpA were recruited from the Third Affiliated Hospital of Sun Yat-sen University, including 280 males and 66 females. A comparison was conducted in terms of age at onset, disease course, family history, HLA-B27 positivity, clinical manifestations, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), the bath ankylosing spondylitis disease activity index (BASDAI) and AS disease activity score (ASDAS), and comorbidities between male and female patients.

Compared with female patients, male patients were younger at disease onset (22±7 vs 27±9, P<0.001),had higher rates of morning stiffness (74.3%), and higher scores of CRP and ASDAS-CRP (P<0.010, P=0.014). However, no significant gender difference was observed in other clinical parameters like clinical manifestations, family history, HLA-B27 positivity, BASDAI, and BASFI and treatment. Male SpA patients had a higher prevalence of Hepatitis B virus (HBV) infection (26.2%) than that of female patients (8.3%), and a higher prevalence of osteoporosis (30.5% vs 14.3%,P<0.01), especially with a lower lumbar T score. Logistic regression analysis reviewed that limited weight (OR=0.94, P<0.001), high ASDAS-CRP (OR=1.58, P=0.006) and male (OR=8.02, P=0.004) are more inclined to have osteoporosis.

Compared with female patients, male patients were younger at disease onset and higher scores of CRP and ASDAS-CRP. No significant gender difference was observed in clinical manifestations, family history, HLA-B27 positivity, BASDAI, and BASFI and treatment. Male SpA patients had a higher prevalence of HBV infection and osteoporosis than female patients. Comorbidities should be paid more attention in the patients with SpA.

To retrospectively evaluate the therapeutic effect and influencing factors of the modified Karlsson operation (anchor method) in treating chronic rupture of the calcaneofibular ligament (CFL).

From August 2010 to May 2014, the data of 24 patients with calcaneofibular ligament rupture treated in Institute of Sports Medicine, Third Hospital of Peking University were retrospectively analyzed. All cases were repaired with modified Karlsson operation (anchor method). There were 14 males and 10 females, with an average age of (30±9) years, and the average body mass index (BMI) was (25±5) kg/m². Visual analogue pain score (VAS), American Foot and Ankle Surgery Association score (AOFAS), Tegner knee motion score, ankle stability and mobility were followed up and analyzed. The paired t test was used to compare the normal distribution data before and after the operation.

The average follow-up time was (41±13) months. Compared with pre-operation, VAS score decreased significantly at the last follow-up [0(0,7) vs 5(0,8), Z=4.13,P=0.000], AOFAS score increased significantly (94±10 vs 70±14, t=8.94, P<0.05), Tegner score increased significantly (4.7±1.5 vs 2.8±1.3, t=6.87, P<0.05), all improved significantly. AOFAS score was excellent in 19 cases, good in 4 cases and moderate in 1 case, the excellent and good rate was 95.8%. Among them, 20 cases (83.3%) were satisfied with the recovery effect after the operation. Postoperative sprain occurred in 5 cases (20.8%) and ankle mobility was limited in 3 cases (12.5%).

The modified Karlsson operation (anchor method) can restore the stability of the ankle joint by treating the chronic rupture of CFL. It is an effective therapy for lateral ankle instability.

To discuss the correlation between histogram analysis of quantitative mono-exponential, bi-exponential and diffusion kurtosis models in diffusion weighted imaging and the Gleason score of prostate cancer, and evaluate the application value and diagnostic efficiency in identifying low and high grade prostate cancer.

A total of 50 patients with histologically confirmed as prostate cancer were examined from May 2015 to May 2016 in the Second Affiliated Hospital of Soochow University using DWI performed at 3.0 T with an extended b-value range from 0 to 2 000 s/mm². Data were post-processed by whole tumor histogram analysis,the ROI was manually drown in DWI (b=1 000 s/mm²) step by step along the outline of cancer, and quantitative analysis were performed respectively by mono-exponential, bi-exponential and diffusion kurtosis models for quantification of apparent diffusion coefficients (ADCs), diffusivity D, pseudo-diffusivity D^*, perfusion fraction f, diffusion coefficients by non-Gaussian distribution (D_k) and kurtosis coefficient (K).Then the histogram analysis was performed to get the mean, median, 25th percentile, 75th percentile, skewness and kurtosis. The correlation between histogram analysis results of these quantitative parameters and Gleason score of prostate cancer were evaluated by Spearman correlation coefficient. The diagnostic performance of histogram analysis results of each quantitative parameters in identifying low (Gleason score≤6) and high (Gleason score>6) grade prostate cancer was performed by comparing the area under the ROC curve and the curve values.

The values of ADC, D and D_k (mean, median, 25th, 75th) were negatively correlated with Gleason score of prostate cancer (r value was -0.388--0.624, P<0.05). The values of D (skewness and kurtosis) had a certain correlation with Gleason score of prostate cancer (r value were 0.413 and 0.402, P<0.05). The histogram analysis results of D^* and f had no statistically significant correlation with Gleason score of prostate cancer (P>0.05). The values of K (mean, median, 25th, kurtosis) were positively correlated with Gleason score of prostate cancer (r value was 0.423-0.699,P<0.05). The diagnostic efficiency of histogram analysis results of these quantitative parameter values in identifying low and high grade prostate cancer showed that the ADC (median), D (25th), D_k (mean) and K (25th) had a larger area under the curve, and were 0.844, 0.873, 0.815, and 0.919 respectively, the differences of area under the curve between any two of these parameters above were not statistically significant (all P>0.05).

The quantitative parameters of three diffusion models (ADC, D, D_k, K) in DWI are all related to the Gleason score of prostate cancer, but in the differential diagnosis of low and high grade prostate cancer, the diagnostic efficacy of mono-exponential model is sufficient. The more complex model such as bi-exponential and diffusion kurtosis may complement it in other ways.

To investigate pathogenic bacteria and drug resistance in the patients with skin and soft tissue infection in order to provide the scientific evidences for clinical reasonable use of antibiotics.

A retrospective analysis was performed on patients with skin and soft tissue infections in Department of Dermatology, Peking University Third Hospital from January 2012 to December 2017. Pus, secretions, skin lesions, urine, throat swabs, and alveolar lavage fluid were collected for bacterial culture, bacterial species were identified by VITEK2 Compact system and BD-Bruker MALDI Biotyper system. Drug resistance was detected by K-B agar diffusion method recommended by CLSI.

A total of 392 strains of bacteria were isolated from 327 patients distributed in 21 genus and 56 species, of which 225 were gram-positive cocci (57.40%), 114 were gram-negative rods (29.08%), 46 were gram-positive rods (11.73%), and 7 were gram-negative cocci (1.79%). The top 3 bacteria were Staphylococcus aureus 91(23.21%), Staphylococcus epidermidis 42 (10.71%), and Pseudomonas aeruginosa 24 (6.12%). Staphylococcus had a high rate of resistance to penicillin and erythromycin (>50%). Gram-negative rods were resistant to ampicillin (86.1%), and also had certain resistance to most second-generation and some third-generation cephalosporin (about 50%). There was no significant change in the drug resistance rate of MRSA compared to MSSA. Only the resistance rate to tetracycline was statistically different (P<0.05).

The emergence of drug-resistant strains is an important factor leading to refractory infections. There are a wide range of pathogenic bacteria species among the skin and soft tissue infection patients, and antimicrobial drugs should be chosen wisely according to drug sensitivity.

To investigate the value of dynamic monitoring of cervical canal length by transperineal ultrasonography in the decision-making of the timing of delivery in patients with complete placenta previa, then to provide clinical guidance for complete termination of placenta.

A total of 130 patients with complete placenta previa from 28 weeks to 30 weeks of gestation between January 2014 and October 2017 in Jiaxing Maternal and Child Health Hospital were selected. There were 66 patients in the experimental group and 64 in the control group, closely monitor the patient′s vital signs, abdominal pain, abdominal distension, vaginal bleeding and fetal intrauterine conditions. In the experimental group, the length of the cervical canal was monitored by perineal ultrasonography at 2 hours and 12 hours after admission. This led to termination of the pregnancy. The control group was instructed to terminate the timing of pregnancy based on the patient′s abdominal pain relief symptoms and vaginal bleeding. Compare the maternal and fetal outcomes of both groups.

The length of the cervical canal was (31.3±1.3) mm when the experimental group was admitted to the hospital, and the length of the cervical canal after the use of the retention drugs 2 h and 12 h was (32.1±0.4) mm and (32.2±0.4) mm, respectively.Compared with the length of the cervix at the time of admission. There was no significant change in the length of the cervical canal after the application of the retention drug 2 and 12 h(all P>0.05). The delivery week of 11 patients in the experimental group did not exceed 34 weeks, and 28 cases in the control group, and there was significant difference between the two groups. Compared with the control group, the difference of birth rate did not exceed 34 weeks, birth weight and hospitalization time decreased significantly (allP<0.05). However, there was no significant difference in maternal outcomes between the two groups.

Through monitoring the length of the cervical canal by perineal ultrasound can make a better decision for the patients of complete placenta previa to chose the time of delivery.

To evaluate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of accessory renal artery (ARA) in patients suspected of renal artery stenosis.

Cases were derived from patients suspected diagnosis of renal artery stenosis during October 2017 and July 2018 by CEUS.A total of 28 kidneys with ARA in 25 cases were diagnosed by dynamic continuous observation by two ultrasound physicians separately. If there was disagreement, the superior physician would made the judgment. DSA or CTA examination was performed at the same period, and its consistency with CEUS diagnosis of ARA was analyzed.

DSA or CTA identified RAS in 32 ARA, color-coded duplex ultrasonography (CCDS) in 12 and CEUS in 28. The sensitivity in detecting ARA was 37.5% for CCDS and 84.4% for CEUS, the specificity was 0% for CCDS and 94.4% for CEUS, while the accuracy was significantly different with CCDS compared with CEUS (60.0% vs 88.0%). Thus, CEUS significantly improved the ARA detection rate compared with CCDS (84.4% vs 37.5%, χ ²=15.56, P<0.01). Compared with CTA or DSA, CEUS showed good consistency in ARA diagnosis (kappa value was 0.752, P<0.05).

CEUS can display and evaluate ARA in real time accurately, which provides a new technology for further clinical research of ARA.

To compare the difference of preoperative planning parameters between 3D-printing non-coplanar template (3D-PNCT) and 3D-printing coplanar template (3D-PCT) in the treatment of pelvic wall recurrent gynecological malignant tumor with radioactive seeds implantation, and to guide the clinical application.

From January 2016 to March 2018, 33 patients with pelvic wall recurrent gynecological malignant tumor were treated with radioactive seeds implantation assisted by 3D-printing template and in Peking University Third Hospital. All patients underwent 3D-PNCT and 3D-PCT preoperative planning. The D₉₀ of target remained similar for the same patient. The parameters were compared with Wilcoxon test or Kruskal-Wallis test.

D₉₀ was similar between the two groups (P>0.05). The number of inserting needles through intestine and bone in 3D-PNCT group was less than that in 3D-PCT group (0 (0-13), 0 (0-25), Z=-2.941, P<0.05;0 (0-3), 0 (0-25), Z=-2.232, P<0.05).

For patients with gynecological malignancies with pelvic recurrence, both of the two peroperative plans could achieve prescription dose, but 3D-PNCT is more safer.

To investigate the impact of hypoxia-reoxygenation environment on the level of autophagy in osteoblasts.

Osteoblasts were purified from the skulls of newborn SD rats within 24-48 hours by tissue block adherence culture and differential centrifugation. The osteoblasts were identified by alizarin red staining and alkaline phosphatase staining. The third generation osteoblasts were cultured in normal state and randomly divided into four groups: group A was cultured under normal condition for 36 hours; group B was cultured under normal condition for 18 hours, then under hypoxia for 18 hours; group C was cultured under hypoxia for 36 hours; group D was cultured under hypoxia for 18 hours, and then under normal condition for 18 hours. The ability to form calcium nodules of osteoblasts in the four groups was observed after culture. The proliferation activity of osteoblasts was detected by CCK-8 assay. The expressions of autophagy specified gene Beclin 1, microtubule-associated protein light chain 3(LC3) and collagen Ⅰ(COL-Ⅰ), bone morphogenetic protein 2 (BMP-2) genes were detected by real time polymerase chain reaction (RT-PCR), and the protein expressions of Beclin 1, LC3-Ⅰ,LC3-Ⅱ and P62 were detected by immunoblotting.

Alizarin red staining showed that osteoblasts in group A had the strongest calcification ability, and calcification ability of osteoblasts in group B,C and D lowered gradually, and it was lowest in group D. The proliferative activity under the CCK-8 detection in group A, B, C and D was 98%±8%, 90%±8%,82%±9%,76%±8%, respectively (F=35.764, P=0.000). The mRNA expression of Beclin 1, LC3-Ⅱthe 4 groups increased gradurally (group D> group C> group B> group A)(F=38.327, 16.583, both P<0.05); and the mRNA expression of COL-Ⅰ, BMP-2 decreased gradually in the 4 groups (group A> group B> group C> group D) (F=20.387, 12.426, both P<0.05). The protein expression of Beclin 1,LC3-Ⅱ/LC3-Ⅰ increased gradually in the groups (group D>group C>group B>group A) (F=26.843, 28.576, bothP<0.05), and the expression of P62 protein decreased gradually (F=18.946, P=0.011).

Hypoxia-reoxygenation environment can reduce the proliferation activity of osteoblasts and up-regulate the expression of autophagy-related genes in osteoblasts. Anoxic reoxygenation environment promotes the increasing of autophagy levels in osteoblasts.

This study aimed to explore the effect of perfluorooctanoate acid (PFOA) on the proliferation, migration and invasion of the human muscle rhabdomyosarcoma RD cell line and its related mechanisms.

RD cells were cultured and exposed to PFOA of different concentrations with 6-72 hours. The cell viability was assessed by cell counting kit-8 (CCK-8) assay. Wound healing and transwell filter assay were used to evaluated the migration and invasion ability of the RD cells respectively. The cell cycles were detected by Flow cytometry. Quantitative real-time PCR and Western blot were used to quantify the mRNA and protein expression difference of related genes, respectively.

CCK-8 assay showed that, after treated the RD cell with different dose of PFOA for 72 h, low dose PFOA (1,10,50, 100 μmol/L) promotes the proliferation of RD cells while high dose PFOA (250, 500 mol/L) inhibits the proliferation ( P<0.001). Flow cytometry showed that compared with the control group, there was no significant difference in G0/G1 phase, while cells in S phase deceased and G2/M phase cells increased after treated with PFOA (50 μmol/L) for 72 h. The relative proportions of S and G2/M were significantly different between the two groups ( P<0.01). The results of qPCR showed that the mRNA relative expression of CDK2 of the control group and the PFOA (50 μmol/L) group were 0.97±0.07 and 2.64±0.11 respectively, and there was a significant difference ( t=12.60, P<0.001); The mRNA relative expression of cyclin E2 of the control group and the PFOA (50 μmol/L) group were 1.33±0.17 and 3.35±0.22 respectively, and there was a significant difference ( t=7.42, P<0.001); The results of Western blot showed that the protein relative expression of CDK2 of the control group and the PFOA (50 μmol/L) group were 0.35±0.01 and 0.84±0.03 respectively, and there was a significant difference ( t=14.60, P<0.001); The protein relative expression of cyclin E2 of the control group and the PFOA (50 μmol/L) group were 0.67±0.04 and 0.86±0.01 respectively, and there was a significant difference ( t=4.88, P<0.01); There was no significant difference in the mRNA and protein expression of p21 and p53 between the PFOA and control group (P>0.05). The wound healing rate of the PFOA (50 μmol/L) group was faster than that of the control group, and the relative migration area of the PFOA group was larger accordingly ( P<0.001). After PFOA (50 μmol/L) treated, the number of the cell through the membranes was much more than the control group ( t=54.40, P<0.001), which means PFOA significantly stimulated the invasion ability of the RD cells. The results of qPCR showed that the mRNA relative expression of vimentin of the control group and the PFOA (50 μmol/L) group were 0.71±0.03 and 2.53±0.16 respectively, and there was a significant difference ( t=11.00, P<0.001); The mRNA relative expression of MMP2 of the control group and the PFOA (50 μmol/L) group were 1.09±0.04 and 10.73±1.20 respectively, and there was a significant difference ( t=8.04, P<0.001). The results of Western blot showed that the protein relative expression of vimentin of the control group and the PFOA (50 μmol/L) group were 0.55±0.06 and 0.81±0.01 respectively, and there was a significant difference ( t=4.50, P<0.05). The protein relative expression of cyclin E2 of the control group and the PFOA (50 μmol/L) group were 0.64±0.04 and 1.03±0.13 respectively, and there was a significant difference ( t=2.94, P<0.05).

Low dose PFOA (50 μmol/L) exposure promotes cell proliferation, migration and invasion in the human muscle rhabdomyosarcoma cell line through inducing the expressions of MMP2, vimentin and cell cycle related genes.

This study aimed to assess the prevalence and factors associated with pelvic organ prolapse (POP) in a representative sample of Chinese urban women.

A total of 29613 Chinese urban women were recruited to this cross-sectional study between February 2014 and March 2016. The prevalence of POP, defined as any stage Ⅱ or higher POP resulting in symptoms, was assessed using questionnaires and physical examinations. Multivariable logistic regression was used to assess factors associated with POP.

2 864 of 29 613 women (9.67%) had POP. The prevalence of POP increased with age ranging from 1.23% (82/6 646) of women aged between 20 and 29 years to 26.11% (727/2 784) for those aged 70 years or older (P<0.000 1). Overweight and obese women were more likely to have POP than normal weight women [AOR=1.56, 95%CI 1.42-1.72 vs AOR=1.74, 95%CI 1.48-2.03]. In the multivariate analysis, the independent risk factors were cough (AOR=1.70, 95%CI 1.44-2.02), constipation (AOR=2.05, 95%CI 1.82-2.32), physical disease (AOR=1.27, 95%CI 1.15-1.41), and gynecological diseases (AOR=2.08, 95%CI 1.89-2.29). Nulliparous (AOR=0.12, 95%CI 0.06-0.22) and caesarean section (CS) (AOR=0.55, 95%CI 0.47-0.64) were protective factors for POP.

POP affects nearly 10% of women in Chinese urban region. The prevalence of POP increases significantly with age. The independent risk factors for POP are body mass index, cough, constipation, physical disease and gynecological diseases. Nulliparous and CS are protective factors for POP.

In this study, the clinical data of patients with liver cancer-related cerebral infarction and simple liver cancer were analyzed by case-control method. It was found that plasma AFP, D-dimer and platelet elevation were independent risk factors for liver cancer-related cerebral infarction. It is suggested that AFP may lead to the occurrence of cerebral infarction associated with hepatocellular carcinoma through the pathway of platelet activation.

Intraspinal angiolipoma is rare in clinic, and misdiagnosis is more common in clinic. A total of 11 cases of intraspinal angiolipoma were treated in Beijing Jishuitan Hospital from October 2003 to February 2017. This article introduces the clinical, imaging characteristics and surgical treatment experience of 11 patients with intraspinal angiolipoma.

To investigate the clinical effect of continuous infusion of methylene blue in the treatment of patients with septic shock. A prospective, single-blind study of the clinical data of 54 patients with septic shock was conducted, and the patients were divided into 3 groups by random number table method (n =18): Basic treatment group (CG, control group), methylene blue (MB) single injection plus basic treatment group (MBG), and MB single injection followed by continuous infusion plus basic treatment group (MBCG). The clinical indexes of patients in each group at different time points were compared and analyzed. The results showed that continuous intravenous infusion of MB could effectively correct the hemodynamic disorder of patients with septic shock, improve the perfusion of peripheral tissues early, improve the microcirculation early, and reduce the mortality rate during hospitalization.

This article reports the case of a patient with pneumoconiosis presenting with hypermetabolic nodules with mediastinal lymphadenopathy. Thoracoscopic exploration was performed. During the operation, extensive dense adhesion was observed in the lower part of the pleural cavity, and a large number of miliary gray-white nodules were scattered in the upper visceral pleura, with a size of 2~5 mm. Carbon end deposition was obvious in the lung tissue around the nodules. No further lung mass resection or biopsy was performed because tuberculosis was not excluded. Some small pleural nodules and right paratracheal enlarged lymph nodes were completely resected and submitted for examination to end the operation. Good recovery after surgery

As one of the components of extracellular matrix, Fibrillin is widely distributed in connective tissue, and its abnormal expression can cause many diseases in various systems. This article reviews the relationship between Fibrillin and the occurrence and development of female reproductive system diseases, and provides reference for the next research.

Frailty is a common geriatric syndrome in elderly patients, and depression is a mental state existing in some elderly patients. When frailty and depression exist at the same time, it will bring poor clinical prognosis to elderly patients, both of which are related to age-related degenerative diseases. Related to diseases, such as disability, osteoporosis, heart failure, stroke, etc. This paper summarizes the common assessment methods of senile depression and senile depression symptoms in recent years and the results of the correlation between them, in order to have some reference significance for the screening and prevention of senile depression and depression.