Application of ropivacaine combination with dexmedetomidine in opioid-free analgesia after cesarean section / 中国药房

OBJECTIVE To investigate the effect of ropivacaine combined with dexmedetomidine on postoperative analgesia in women undergoing cesarean section， and to explore the feasibility of the opioid-free analgesia mode after cesarean section under spinal-epidural anesthesia. METHODS Totally 80 women undergoing cesarean section were randomly divided into observation group （ropivacaine combined with dexmedetomidine for analgesia） and control group （ropivacaine combined with opioid drug sufentanil for analgesia） ， with 40 cases in each group. The exercise and rest score in visual analogue scale （VAS） within 48 hours after operation， the use of analgesia pump （the time of first analgesia pump pressing， the times of analgesia pump pressing within 24 hours and 48 hours after operation）， the time of block （the onset time of spinal anesthesia sensory block， the time to the highest level of spinal anesthesia sensory block， the time of sensory recovery and the time of movement recovery） ， the time of prognosis （the time of gastrointestinal ventilation recovery， the time of getting out of bed and the hospitalization time）， and the incidence of adverse events were compared in 2 groups. RESULTS Finally， 64 parturients （32 in the observation group and 32 in the control group） were involved in the analysis. Compared with the control group， the recovery time of sensation and movement were significantly prolonged， the ventilation time was significantly shortened， and the incidence of nausea， vomiting and abdominal distension was significantly decreased in the observation group （P＜0.05） . There was no significant difference in the other indexes between the two groups （P＞0.05）. CONCLUSIONS Ropivacaine combined with dexmedetomidine under spinal-epidural anesthesia could provide similar analgesic effect as combined with opioids drug sufentanil， shorten the time of gastrointestinal ventilation recovery， and reduce the incidence of nausea，vomiting and abdominal distension， with no increased risk of low blood pressure or urinary retention.

25G pars plana vitrectomy combined with Dexamethasone intravitreal implants for the treatment of vitreous hemorrhage and diabetic macular edema secondary to proliferative diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical effect of 25G pars plana vitrectomy(PPV)combined with dexamethasone intravitreal implant(DEX)on the treatment of vitreous hemorrhage and diabetic macular edema(DME)secondary to proliferative diabetic retinopathy(PDR).METHODS: Prospective clinical case study. A total of 40 patients(40 eyes)with vitreous hemorrhage and DME secondary to PDR who treated in Tianjin Eye Hospital from July 2020 to January 2022 were included in the study. All eyes underwent 25G PPV and cataract phacoemulsification. The patients were randomly divided into PPV group(20 eyes)and PPV+DEX group(20 eyes). Best corrected visual acuity(BCVA), intraocular pressure, and central macular thickness(CMT)of the patients before and 1, 3, 6mo after the operation were compared.RESULTS: All patients were followed up for 6mo. The BCVA of the patients in the PPV+DEX group improved better than that of the PPV group at 1, 3 and 6mo after surgery(P<0.05). CMT of the PPV+DEX group was lower than that of the PPV group at 1mo after operation(P<0.05). Retinal neovascularization or CMT regression with less than 5% was found in 8 eyes in the PPV group, who were supplemented with anti-vascular endothelial growth factor, while it was found in only 1 eye in the PPV+DEX group(P<0.05).CONCLUSION: PPV combined with DEX could yield synergies, which provide better therapeutic effect for the patients with vitreous hemorrhage and DME secondary to PDR.

The 3'-untranslated region contributes to the pregnane X receptor (PXR) expression down-regulation by PXR ligands and up-regulation by glucocorticoids

Pregnane X receptor (PXR) is the major regulator of xenobiotic metabolism. PXR itself is controlled by various signaling molecules including glucocorticoids. Moreover, negative feed-back regulation has been proposed at the transcriptional level. We examined the involvement of the 3'-untranslated region (3'-UTR) of mRNA and microRNAs in PXR- and glucocorticoid receptor (GR)-mediated regulation of gene expression. PXR ligands were found to significantly downregulate mRNA expression in a set of 14 human hepatocyte cultures. Similarly, PXR was downregulated by PCN in the C57/BL6 mice liver. In mechanistic studies with the full-length 3'-UTR cloned into luciferase reporter or expression vectors, we showed that the 3'-UTR reduces PXR expression. From the miRNAs tested, miR-18a-5p inhibited both expression and gene induction. Importantly, we observed significant upregulation of miR-18a-5p expression 6 h after treatment with the PXR ligand rifampicin, which indicates a putative mechanism underlying negative feed-back regulation in hepatic cells. Additionally, glucocorticoids upregulated expression not only through the promoter region but also 3'-UTR regulation, which likely involves downregulation of miR-18a-5p. We conclude that miR-18a-5p is involved in the down-regulation of expression by its ligands and in the upregulation of mRNA expression by glucocorticoids in hepatic cells.

Studies on high-efficiency loading, sustained-release and permeability as transdermal delivery of graphene oxide to docetaxel composites / 中草药

Objective: To synthetize the new-type GO-DEX-β-CD/DOC and Fe3O4/GO-Na/DOC inclusion compound, and study its high-efficiency loading, sustained-release and permeability as transdermal delivery for docetaxel (DOC) composites. Methods: The concentration of DOC was determined by high efficiency liquid chromatography. The high-efficiency loading, sustained-release and permeability as transdermal delivery of GO-DEX-β-CD/DOC and Fe3O4/GO-Na/DOC were studied, and the encapsulation efficiency and drug loading of them were determined by centrifugation. The GO-DEX-β-CD/DOC and Fe3O4/GO-Na/DOC were applied onto the female mice skin in vitro and in vivo to develop the permeability of them. Results: The encapsulation efficiency and drug loading of Fe3O4/GO-Na/DOC were higher than GO-DEX-β-CD/DOC, and its slow release property and permeability as transdermal delivery were better. The results showed that the accumulation permeation amount was (22.512 ± 0.715) μg after Fe3O4/GO-Na/DOC being applied over 90 h, DOC concentration in skin reached a peak at 15 min by the application of Fe3O4/GO-Na/DOC. After 5 h of administration, DOC concentration in the blood of female mice reached (76.886 ± 1.232) μg/mL. Conclusion: The preparation techniques of Fe3O4/GO-Na/DOC was feasible with better sustained release and transdermal effect, which had a promising application prospect.

¿Podemos mejorar la cicatrización de un desgarro muscular masivo? / Can we improve the healing of a massive muscle tear?

OBJETIVOS: Evaluar macroscópica e histológicamente la cicatrización muscular utilizando Dexametasona (DEX) o Traumeel (TRM), en un modelo experimental animal. MATERIAL Y MÉTODOS: Estudio experimental en 45 ratones BKS. Se seccionó transversal y completamente el cuádriceps derecho en todos los animales. Se definieron 3 grupos de estudio de 15 ratones cada uno, un grupo control, un grupo tratado con Dexametasona y uno con Traumeel. Los animales fueron sacrificados a las 1,2 y 4 semanas después del procedimiento y se les extrajo ambos cuádriceps (derecho como intervención e izquierdo como control) y luego fueron analizados macroscópica e histológicamente por un patólogo calificado, de manera ciega. Los datos se analizaron estadísticamente con el test de Kruskal - Wallis (p < 0,05), utilizando el programa Stata V12.1. RESULTADOS: Macroscopía: A la semana, en todos los grupos se evidenció ausencia de cicatrización con gap persistente. A la segunda semana, se evidencia cicatrización inicial sin gap en todos los grupos. A las 4 semanas todas las muestras estaban cicatrizadas. HISTOLOGÍA: La administración de Dexametasona disminuye el infiltrado inflamatorio y aumenta las fibras regenerativas, pero induce mayor fibrosis y pérdida de masa muscular. La adición de Traumeel aumenta la cantidad de fibras regenerativas, pero incrementa el infiltrado inflamatorio. CONCLUSIONES: A las 4 semanas ninguno de los grupos de estudio presentó regeneración muscular completa, con resultados macroscópicos e histológicos variables.

OBJETIVES: To macroscopically and histologically evaluate a muscle strain healing model, using Dexamethasone and Traumeel. MATERIALS AND METHODS: Experimental study in 45 BKS mice. 3 groups of 15 mice were defined: control group, Dexamethasone treated group and Traumeel treated group. The animals were sacrificed at the 1st, 2nd and 4th week, both quadriceps were resected (right as intervention and left as control) and then analyzed macroscopically and histologically by a qualified and blinded pathologist. Results were analyzed statistically using Kruskal - Wallis test (p<0.05). RESULTS: Macroscopy: the first week, all groups showed absence of healing with persistent gap. At the 2nd week, evidence of initial healing without gap in all groups. By week 4, all samples were healed. HISTOLOGY: Dexamethasone decreased the inflammatory infiltration and increased the regenerative fibers, but induced a higher fibrosis and loss of muscle mass. Traumeel increased the amount of regenerative fibers and the inflammatory infiltration. DISCUSSION: The results of our study fail to define a definitive posture. We observed that Traumeel actually increases the amount of regenerative fibers and contrary to the literature, it increases the inflammatory infiltrate. On the other hand, Dexamethasone showed similar results in both regenerative fibers, fatty infiltration and muscle mass, but with increased necrosis. CONCLUSIONS By the 4th week none of the groups showed complete muscle regeneration with macroscopic and histological variable results.

Comparison of polycytidylic acid-induced and dexamethasone-induced thymic atrophy and their thymic expression of RIG-Ⅰ like receptors signaling pathway / 中国免疫学杂志

Objective:To provide experimental evidences for choosing murine models in the pathogenesis research of thymic impairment induced by viral infection,we compared the impacts of polycytidylic acid(Poly(I:C)) and dexamethasone(DEX) on the thymic morphology and thymic output function,and explored the implication of RLR signaling pathway.Methods: 24 male C57BL/6 mice were randomly assigned into three groups and treated with Poly(I:C),DEX,or saline respectively.Thereafter,their thymic morphology,pathological changes,thymic index,and thymic pathology were examined.Their contents of T-cell receptor excision circles (TRECs) and proportions of the naive CD4+T cell in the peripheral blood were determined to evaluate their thymic output function.The expression levels of thymic RLR/MAVS/IFN-α/β signaling pathway and IL-1β were also measured.Results: Both Poly (I:C) and DEX treatment caused thymic atrophy in appearance and structural destruction under the microscope inspection,and DEX treatment did much more severe damage,especially to the thymic cortex.TRECs decreased significantly in both groups.The proportions of na?ve/memory CD4+T cell subsets remained stable,though total CD4+T cell decreased in DEX group,while the proportion of na?ve CD4+T cell in Poly (I:C) group increased significantly.The expression of RIG-Ⅰ,MDA5,LGP2,and IFN-α/β were up-regulated in DEX group, while it remained unchanged in Poly (I:C) group.Conclusion:Both Poly (I:C) and DEX induced thymic atrophy and the impaired thymic output function.Nevertheless,the expression of RLR-IFN signaling pathway up-regulated more significantly in DEX group instead of in Poly (I:C) group.These results implied the existence of different pathological manifestations and mechanisms underlying the impaired thymic function in different animal models,as well as impact on na?ve/memory CD4+T cell proportions.Our research provides references for choosing animal models in the basic research and drug development for viral infection induced thymic atrophy based on the RLR signaling pathway.

Analysis of the Relationship of Drug Utilization Index with Anti-infective Effect of AECOPD Patients / 中国药房

OBJECTIVE:To investigate the relationship of drug utilization index(DUI)of antibiotics with therapeutic efficacy of patients with acute exacorbation of chronic obstructive pulmonary disease(AECOPD). METHODS:By the method of drug utili-zation evaluation,inpatients with AECOPD in our hospital during 2013-2015 were selected as the research object. Diagnosis and treatment information prescribing information of patients were collected,and inpatients only receiving one kinds of antibiotics dur-ing hospitalization stay were selected to evaluate the relationship of therapeutic efficacy with rehospitalization indexes. RESULTS:A total of 2155 AECOPD patients were enrolled in the study. Among antibiotics with DDDs>500,antibiotics with DUI close to 1.0 was cefotiam hydrochloride for injection,and that with DUI far higher than 1.0 was Cefodizime sodium for injection,while that with DUI much less than 1.0 was Piperacillin sodium and sulbactam sodium for injection. There was statistical significance in therapeutic efficacy between Cefotian hydrochloride for injection and Piperacillin sodium and sulbaactam for injection (P0.05). There was no statistical significance in therapentic efficacy or rehospital-ization between cefotiam hydrochloride for injection and cefodizimes sodium for injection(P>0.05). CONCLUSIONS:DUI is as-sociated with therapeutic efficacy,but the rationality of antibiotics can not be simple judged according to the distance between DUI and 1.0. A variety of confounding and bias factors should be integrated to avoid misreading and misjudgment.

Study on Active Fractions of Macrothelypteris Oligophlebia for Chronic Non-bacterial Prostatitis in Rats / 中国药师

Objective:To explore the effect of the methanol extract of Macrothelypteris oligophlebia on chronic non-bacterial prosta-titis ( CNP) in rats to confirm the active fractions. Methods:The powdered rhizomes of M. oligophlebia were soaked in methanol. The methanol extract was suspended in water and then extracted successively with chloroform and ethyl acetate to obtain chloroform fraction, ethyl acetate fraction and water fraction. Carrageenan-induced CNP in rats was established. The rats were randomly divided into the sham-operated control group, model group, positive control group, methanol extract group, ethyl acetate fraction group, chloroform fraction group and water fraction group. The anti-prostatitis effect was evaluated by the prostate index, and the pathological examination of prostate was performed using HE staining. The levels of interleukin-10 (IL-10), tumor necrosis factor alpha (TNF-α), cyclooxyge-nase-2 (COX-2) and prostaglandin E2(PGE2) were analyzed using ELISA kits. Results:The ethyl acetate fraction group and metha-nol extract group with high flavonoid content could significantly decrease prostate index (P<0. 01) and the levels of IL-10, TNF-α, COX-2 and PGE2(P<0. 05 or P<0. 01), and improve the prostate morphology when compared with the model group, especially with the ethyl acetate fraction group. Conclusion:The rhizomes of M. oligophlebia show promising therapeutic effect on CNP, and the ethyl acetate fraction is the active fraction.

PI3K/Akt/mTOR pathway participates in neuroprotection by dexmedetomidine inhibits neuronic autophagy following traumatic brain injury in rats.

Dexmedetomidine (Dex) has been demonstrated to provide neuroprotective effect against brain injury in the central nervous system. However, the underlying mechanism of this neuroprotection remains unclear. In this study, we explored whether Dex has the protective potential in rat models of traumatic brain injury(TBI). More importantly, our study further investigated the role of neuronic autophagy induced by PI3K/Akt/mTOR pathway in this neuroprotective action. Adult male Sprague-Dawley rats were subjected to a diffuse cortical impact injury caused by a modified weight-drop device and Dex (15ug/kg, i.v.) was administered immediately after TBI. Wet-dry weight method was used to evaluate brain edema. Motor function outcome was assessed by Neurologic Severity Score and the spatial learning ability was evaluated in a Morris water maze. The co-localization of microtubule-associated protein 1 light chain 3(LC3) and neuronal nuclei (NeuN), or LC3 and mammalian target of rapamycin (mTOR) were analyzed by immunofluorescence respectively. The expression of LC3, Phosphorylated protein kinase B (p-Akt) and p-mTOR were quantified using Western blot analysis. Our results showed treatment of rats exposed to TBI with Dex caused not only marked reduction in cerebral edema, motor and cognitive functions deficits, but also a decrease in LC3 levels and a increase in p-Akt and p-mTOR levels. Taken together, these findings indicated that treatment with Dex after TBI could inhibited neuronic autophagy in the hippocampus mediated by the activation of the PI3K/Akt/mTOR pathway, finally promoting neurological recovery.

The effects of enhanced external counterpulsation on arterial elasticity in patients with cerebral ischemic stroke / 中国神经精神疾病杂志

Objectives To examine the effects of enhanced external counterpulsation on arterial elasticity in stroke patients to provide clinical evidence for secondary prevention of patients with cerebral ischemic stroke. Methods Total 192 patients with ischemic stroke were enrolled and then divided into the EECP (n=107) and control (n=85) group. Auto-matic measurement synchronous atherosclerosis detector was use to measure brachial-ankle pulse wave velocity (BaP-WV) and cardio-ankle vascular index (CAVI). The difference of BaPWV and CAVI were evaluated before, at 36 hours and one month after EECP. Results The BaPWV and CAVI significantly decreased at 36 hours and 1 month after treat-ment in EECP groups compared to either pre-therapy or control groups (all P<0.05). Conclusions EECP can signifi-cantly reduce the BaPWV and CAVI and improve the arterial elasticity in patients with cerebral ischemic stroke. Thus, arterial elasticity may be an important index to evaluate the effects of EECP on cerebral ischemic stroke.

Comparison of the efficacies of hyaluronidase and dexamethasone on skin damage caused by vinorelbine extravasation in rats / 肿瘤研究与临床

Objective To compare the efficacies of intralesional hyaluronidase(HAase), intralesional dexamethasone(DEX), and intralesional HAase plus intralesional DEX on skin damage caused by vinorelbine extravasation in a rat model. Methods After establishing an animal model with vinorelbine extravasation in each lower extremity of 40 Sprague-Dawley rats, we treated the rats with intralesional HAase,intralesional DEX, intralesional HAase plus intralesional DEX,intralesional saline,or received no treatment as control.The wound area on 1 d, 4 d, 8 d, 12 d, 18 d, 24 d, 30 d and the time of healing were observed and compared.Results The wound area on 1 d, 4 d, 8 d, 12 d, 18 d and 24 d was significantly lower in intralesional HAase group, intralesional DEX group,intralesional HAase plus intralesional DEX group,and intralesional saline group than that in control group (P ＜0.05), and that was significantly lower in intralesional HAase group and intralesional HAase plus intralesional DEX group than that in intralesional DEX group and intralesional saline group (P ＜0.05). The healing time was significantly shorter in 4 therapy groups than that in control group [(25.1±3.1) d, (27.9±2.8) d, (23.0±3.2) d, and (28.4±3.9) d vs.(31.2±3.0) d, P ＜0.05], and that was significantly lower in intralesional HAase group and intralesional HAase plus intralesional DEX group than that in intralesional DEX group and intralesional saline group (P ＜0.05). Conclusion The monotherapy with intralesional HAase or intralesional DEX, with decreasing the extent of skin damage and shortening the healing time, is effective therapy for skin damage caused by vinorelbine extravasation, and the monotherapy with intralesional Haase is more efficacious. The efficacy of intralesional HAase plus intralesional DEX seems better than that of monotherapy.

Neuroprotective effects of astragalosides against amyloid β-protein and DEX-induced neurotoxicity in rat hippocampal neurons / 中草药

Objective: To study the effect of astragaloside (AST) on the injury induced by amyloid β-protein (Aβ) plus Dexamethasone (DEX) in rat hippocampal neurons. Methods: In vitro, the effects of AST on hippocampal neurons cell death with Aβ plus DEX were detected by MTT assay and intracellular calcium ([Ca2+]i); The effects of AST on phospho-tau (P-tau) protein were analyzed to explore the mechanisms responsible for DEX enhanced Aβ-induced cell death in hippocampal neurons. Results: AST (10, 20, and 40 μg/mL) could protect hippocampal neurons against DEX (10 μmol/L) plus Aβ25-35 (5 μmol/L) - induced hippocampal neuronal injury of felal rat in vitro (P<0.01). AST could inhibit the increased levels of [Ca2+]i and P-tau protein level induced by DEX (10 μmol/L) plus Aβ25-35 (5 μmol/L) (P < 0.05). Conclusion: AST could protect hippocampal neuron against synergistic neurotoxicity of Aβ and DEX.

Influence of dexamethasone on foxml gene expression in pulmonary tissue following acute lung injury / 中华急诊医学杂志

Objective To study the foxml gene and its protective effect on the lung tissue of rats with acute lung injury (ALI) induced by lipopolysaccharide (LPS), and to observe the dexamethason' s (DEX) impacts on foxml gene and the prognosis of ALI. Method Seventy-two healthy mice were randomly(random number) divid-ed into three groups: control group (A group, n = 24), model group (B group, n = 24) and DEX treatment group (C group, n = 24). The observing intervals were respectively set in 24 h, 48 h and 72 hours. At each ob-serving interval, the foxml protein in lung tissue of mice was detected by using immunohistochemistry (IHC), and the expression of foxml gene in lung tissue was detected by using RT-PCR, as well as to observe the pathological changes in lung tissue. Results Comparisons were made between paired groups at 24 h,48 h and 72 h intervals in which the expression of foxml mRNA and the level of foxml protein in lung tissue of mice in C group were signifi-cantly higher than those in B group (P < 0.05), and those in B group were significantly higher than those in A group (P < 0.05). The expression of foxml mRNA and the level of foxml protein in lung tissue of mice in B group at 48 h interval were significantly higher than those both at intervals of 72 h and 24 h (P < 0.05), and the those at 72 interval were significantly higher than those at 24 h interval (P < 0.05). Compared with B group, the pathologi-cal changes in lung tissue of mice in C group were lessened. Conclusions In both model group and dexamethasone treatment group, the expression of foxml mRNA and the level of foxml protein in lung tissue of mice are increased significantly. Dexamethasone lessens the injury of both vascular endothelial cells and alveolar epithelial ceils of lung tissue, and it also significantly increases the expression of foxml mRNA and the level of foxml protein.

Change regulatives of bone mineral density after total ankle arthroplasty:six cases results in connective three years / 中国矫形外科杂志

[Objective] To study the change regulatives of BMD(bone mineral density)in after total ankle arthroplasty.[Methods]From Oct.1997 to Dec.2004,the BMD of the subjects were measured to involve in the study.There were 6 cases(5 male,1 female)with an average of 54.4 years old.Their BMD of the subjects was measured by DEX-A(Lunar)at the tibia and talus of the ankle post-arthroplasty in 6 months,12 months,2 years and 3 years postoperatively.All data were saved in computer and all statistical analyses were performed uaing SPSS 8.0 system in personal computer.[Results]The bone trabecula growing into micropore coated of the prosthesis has been showed on radiograth post-surgeryat average period of 1.5 years to 2 years.In the third year itreached bone mass at the distal tibia and talus of the total ankle replacement,which mean BMD 0.854?0.217 at post operative 6 months,BMD 0.975?0.142 at post operative 12 months,BMD 0.956?0.213 at post operative 2 years,and 1.155?0.210 at 3 years(P

Problems in osteogenic differentiation of rat bone marrow stromal cells

The effect of rhBMP-2 in human bone marrow-derived stem cells as osteogenic inducers

Comparison of Pharmacia CAP system and Auro Dex(R) Visual ENS(TM) screening test for detecting specific IgE in atopic patients / 천식및알레르기

BACKGROUND AND OBJECTIVE: Auro Dex(R) Visual ENS(TM) allergy screening test is a simplified and newly developed method for the detection of allergen-specific IgE in human serum. This system has advantages in several ways compared to the Pharmacia CAP system, such as the need for relatively small amounts of serum, no expensive equipment and rapid detection. The purpose of this study is to evaluate the efficiency of Auro Dex(R) Visual ENS(TM) screening test for the detection of specific IgE compared to the Pharmacia CAP system in atopic patients. METHOD: In 27 atopic patients (M:F = 11:16, age:13-51 years, average 27.9+/-10.2 years) who had positive response on skin prick test, the Pharmacia CAP system for the sensitized allergen and Auro Dex(R) Visual ENS(TM) screening test were performed. For comparison, 5 normal subjects who had negative response on skin prick test were tested for 5 allergens(Dermatophagoides(D) farinae, D. pteronyssinus, cockroach, dog epithelium, cat epithelium) by the Pharmacia CAP system and Auro Dex(R) Visual ENS(TM) screening test. RESULTS: Using skin prick test results as the reference standards, the sensitivity of the Pharmacia CAP system and Auro Dex(R) Visual ENS(TM) screening test was 87.5%, 57.1%, respectively. The specificity of Pharmacia CAP system and Auro Dex(R) Visual ENS(TM) screening test were 100%. There was a significant correlation between the Auro Dex(R) Visual ENS(TM) and CAP system (D.f. r=0.755, D.p. r=0.856) for D. farinae and D.pteronyssinus. CONCLUSION: Auro Dex(R) Visual ENS(TM) screening test showed high specificity for detection of allergen-specific IgE and good correlation with the Pharmacia CAP system. This system may be useful in general practice. However, due to relatively low sensitivity to some antigens compared to skin prick test, further development may be necessary.

Combined Dexamethasone/Insulin-induced Hypoglyeemic Test in Manic and Schizophrenic Patients

Many investigators are trying to elucidate the pathogenesis of psychiatric disorders on the basis of neuroendocrine responses to stimulation or perturbation. Dexamethasone(DEX) suppression has been the most widely utilized as the prototypical challenge test. Dexamethasone suppression test(DST) has proven to be valuable in diagnosing the depressive spectrum disorder. Reported specificity of diagnosis of depression is relatively high, but sensitivity is limited. Some researchers used the combination of dexamethasone and corticotropin releasing hormone(CRH) in order to improve the sensitivity. They reported that combined DEX/CRH test, i.e., we administered the insulin instead of CRH. Total subjects were 28(7 normal controls, 10 manic patients, 11 schizophrenic, patients). Subject were token DEX(1.5mg p.o.) at 11 p.m., insulin 16 hours later(0.1 unit/kg i.v.). Five blood samples for the determination of cortisol and ACTH were serially drawn at 15 minute interval. The results are as following : 1) The cortisol an ACTH levels of manic subjects increased following insulin administration. Manic subjects showed higher levels of cortisol and ACTH than schizophrenic and normal control subjects. The cortisol and ACTH levels of schizophrenic and normal control subjects did not show gross changes. 2) The sensitivity of the test was lower than that of reported DEX/CRH test.