首次确诊帕金森病患者情绪和认知功能障碍的关系

目的观察研究首次确诊帕金森痛患者情绪和认知功能障碍之间的关系。方法60例首次确诊帕金森病（PD）患者,采用简易智能状态检查量表（MMSE）和词ir-流畅性测验评定患者的认知功能;采用汉密尔顿抑郁量表（HAMD）和汉密尔顿焦虑量表（HAMA）评定患者的情绪障碍。采用统一帕金森病评分量表（UPDRS）和改良Hoehn—Yahr分级评定患者的帕金森病严重程度。结果（1）60例首次确诊PD患者改良H0ehn～Yahr分级显示：I级11例,Ⅱ级32例,Ⅲ级16例,Ⅳ级1例。其中具有抑郁障碍患者28例,占46．7％;具有焦虑障碍患者20例,占33．3％,20例焦虑障碍PD患者都具有抑郁障碍。（2）60例首次确诊PD患者中,具有认知功能障碍患者23例,占38．3％;MMSE评分和词汇流畅性测验评分均与病程呈负相关,差异具有统计学意义（r分别为-0．42,-0．46;P〈0．05）。（3）60例首次确诊PD患者HAMD评分和MMSE评分及词汇流畅性测验评分呈负相关,差异具有统计学意义（r分别为-0．69,-0．76;P〈0．01）。PD患者HAMA评分和MMSE评分及词汇流畅性测验评分亦呈负相关,差异具有统计学意义（r分别为～0．60,-0．68;P〈0．01）。结论首次确诊PD患者多为轻、中度患者,早期即表现情绪障碍和认知功能障碍,且两者具有高度相关性。     

Trends in Prevalence of Serious Psychological Distress and Depression Among Adults with Stroke in the United States

ObjectivesTo examine national trends in prevalence of serious psychological distress and depression among adults with stroke in the United States (US) from 2004 to 2017, and variations across sociodemographic subgroups.MethodsData were obtained from the household components of the 2004-2017 Medical Expenditure Panel Survey, a nationally representative survey in the US. History of stroke or transient ischemic attack was based on self-report. Psychological distress was measured by the Kessler-6 scale, and depressive symptoms were measured by the 2-item Patient Health Questionnaire. Logistic regression models were used to examine the trends in prevalence of serious psychological distress and depression overall and by age, sex, and race/ethnicity.ResultsAmong 10889 participants with stroke or transient ischemic attack, 60.0% were aged ≥ 65, 54.4% were female, and 72.2% were non-Hispanic white. The prevalence of serious psychological distress decreased from 14.9% in 2004-2005 to 11.3% in 2016-2017, corresponding to 7% lower odds every 2 years (adjusted odds ratio [aOR0.93, 95% confidence interval [CI]=0.89-0.97); and the prevalence of depression decreased from 23.1% in 2004-2005 to 18.3% in 2016-2017, corresponding to 5% lower odds every 2 years (aOR=0.95, 95% CI=0.92-0.98), after adjustment for sociodemographic characteristics, functional limitations, and antidepressant use. The trends varied significantly by age, but not sex and race/ethnicity. The overall decline was mainly driven by older adults above age 64.ConclusionsPrevalence of serious psychological distress and depression among US adults with stroke decreased from 2004 to 2017, but the burden of mental health problems remained high.     

131I联合促甲状腺激素抑制治疗对分化型甲状腺癌血生化及骨密度的影响

目的  观察术后131I联合促甲状腺激素（TSH）抑制治疗的分化型甲状腺癌（DTC）患者,研究TSH抑制治疗对血生化及骨密度（BMD）的影响。方法  选择DTC术后患者44例,均在术后使用131I清除残余甲状腺,“清甲”治疗后及时给予甲状腺素片行TSH抑制治疗,TSH抑制至<0.1 mU/L。“清甲”治疗6个月左右,进行“清甲”是否成功的“评估”或“清灶”治疗。患者2次入院均空腹测定血生化全套,包括谷丙转氨酶（GPT）、谷草转氨酶（GOT）、碱性磷酸酶（AKP）、血糖（GLU）、尿素氮（BUN）、肌酐（Cr）、钙（Ca）、磷（P）、总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、降钙素（CT）、骨钙素（BGP）、甲状旁腺激素（PTH）、25羟维生素D3（VD3）;2次入院均测定腰椎（L1~4）、左股骨颈（Neck）、左大转子（Troch）、左沃氏三角区（Ward’s）的BMD（g/cm2）。2次入院数据的差值以Δ表示,如ΔGPT=GPT1-GPT2。结果  ①年龄和Ward1呈负相关,而且年龄和Neck2、Ward2负相关更明显,多元回归方程也有一致结果（Ward2=1.001~0.008）;年龄与ΔWard呈正相关。②术后时间间隔平均60.5 d,与ΔBGP呈负相关,与4个部位BMD无显著相关性。③TSH抑制时间与BGP2呈负相关,与Neck2呈正相关。结论  短期内（6个月左右）131I联合TSH抑制治疗对BMD的影响较小,仅表现为年龄和Ward呈负相关,且越是高龄患者治疗后Ward更低、ΔWard越大;术后时间间隔及TSH抑制时间对BMD的影响不显著。

     

Aging aggravates long-term renal ischemia-reperfusion injury in a rat model

Aim

Ischemia-reperfusion injury (IRI) has been considered as the major cause of acute kidney injury and can result in poor long-term graft function. Functional recovery after IRI is impaired in the elderly. In the present study, we aimed to compare kidney morphology, function, oxidative stress, inflammation, and development of renal fibrosis in young and aged rats after renal IRI.

Materials and methods

Rat models of warm renal IRI were established by clamping left pedicles for 45 min after right nephrectomy, then the clamp was removed, and kidneys were reperfused for up to 12 wk. Biochemical and histologic renal damage were assessed at 12 wk after reperfusion. The immunohistochemical staining of monocyte macrophage antigen-1 (ED-1) and transforming growth factor beta 1 (TGF-β1) and messenger RNA level of TGF-β1 in the kidney were analyzed.

Results

Renal IRI caused significant increases of malondialdehyde and 8-hydroxydeoxyguanosine levels and a decrease of superoxide dismutase activity in young and aged IRI rats; however, these changes were more obvious in the aged rats. IRI resulted in severe inflammation and tubulointerstitial fibrosis with decreased creatinine (Cr) clearance and increased histologic damage in aged rats compared with young rats. Moreover, we measured the ratio of Cr clearance between young and aged IRI rats. It demonstrated that aged IRI rats did have poor Cr clearance compared with the young IRI rats. ED-1 and TGF-β1 expression levels in the kidney were significantly higher in aged rats than in young rats after IRI.

Conclusion

Aged rats are more susceptible to IRI-induced renal failure, which may associate with the increased oxidative stress, increased histologic damage, and increased inflammation and tubulointerstitial fibrosis. Targeting oxidative stress and inflammatory response should improve the kidney recovery after IRI.     

Performance of the Steno type 1 risk engine for cardiovascular disease prediction in Italian patients with type 1 diabetes

Background and aimsPremature cardiovascular disease cause excess mortality in type 1 diabetes (T1D). The Steno T1D Risk Engine was developed and validated in northern European countries but its validity in other populations is unknown. We evaluated the performance of the Steno T1D Risk Engine in Italian patients with T1D.Materials and methodsWe included patients with T1D with a baseline visit between July 2013 and April 2014, who were free of cardiovascular disease and had complete information to estimate risk. The estimated cardiovascular risk score was compared with the 5-year rate of cardiovascular events by means of logistic regression.ResultsAmong 223 patients (mean age 43 ± 13 years, 34.5% male, mean duration of diabetes 22 ± 12 years) the mean estimated cardiovascular risk at 5 years was 5.9% (95% C.I. 5.2–6.5%). At baseline, high estimated risk discriminated the presence of asymptomatic atherosclerosis better than microangiopathy, and was not associated with markers of inflammation or endothelial activation. After a mean follow-up of 4.7 ± 0.5 years, only 3 cardiovascular events were observed and nonetheless the risk score was significantly associated with their incidence (OR 1.22; 95% C.I. 1.08–1.39, p = 0.001). However, the observed event rate was significantly lower than the estimated one (3 vs 13; 95% C.I. 12–14; p < 0.001).ConclusionThe Steno T1D Risk Score identified subjects with subclinical atherosclerosis and high cardiovascular risk in an Italian T1D population. However, the absolute risk was significantly overestimated. Further studies in larger population are needed to confirm these results.     

Time spent in target range assessed by self-monitoring blood glucose associates with glycated hemoglobin in insulin treated patients with diabetes

Background and aimsSelf-monitoring blood glucose (SMBG) remains a widespread tool to monitor blood glucose. The development of diabetes management systems (DMS) allows SMBG to provide additional information as time spent in target range (TIR). This study evaluates the association between HbA1c and TIR, evaluated through DMS, over 2 months, and 2 weeks.Methods and resultsType 1 (T1D) and Type 2 (T2D) insulin-treated patients with diabetes were enrolled. We used the term PIR (Points in Range) instead of TIR, since SMBG provides point-in-time glucose values rather than a continuous trend over time. PIR was calculated in 2-month and 2-week time ranges before available HbA1c measurement.One-hundred ninety-seven patients with T1D and 36 with T2D were recruited. HbA1c and PIR were inversely associated (2 months: R -0.72, 2 weeks R -0.70; p < 0.0001) in all subjects. The relationship did not change when T1D and T2D patients were analyzed separately. For every 10% change of PIR, there was a change of HbA1c by 0.4%.ConclusionsOur study, for the first time, demonstrates a significant correlation between HbA1c and PIR calculated by DMS. DMS offers additional information useful in disease management of patients with T1D and T2D performing SMBG.     

Adipose-derived mesenchymal stromal cells suppress osteoclastogenesis and bone erosion in collagen-induced arthritis

Osteoclasts are responsible for bone destruction in rheumatoid arthritis (RA), and adipose-derived mesenchymal stromal cells (ADSCs) can inhibit experimental collagen-induced arthritis model. This study aims to determine whether ADSCs also suppresses osteoclastogenesis and bone erosion in collagen-induced arthritis (CIA). Osteoclasts were induced from bone marrow-derived CD11b⁺ cells with receptor activator of nuclear factor-κ B ligand (RANKL) and macrophage colony-stimulating factor (M-CSF) stimulation and assessed with tartrate-resistant acid phosphatase (TRAP) staining. For human cells, osteoclasts were produced from human CD14⁺ cells. ADSCs were generated and added to cultures with different ratios with CD11b⁺ cells. Transwell and antibody blockade experiments were performed to define the mechanism of action. NF-κB and RANKL expression were determined by Western blotting and RT-qPCR. About 2 × 10⁶ ADSCs or fibroblast cells were adoptively transferred to DBA1/J mice on day 14 after immunization with type II collagen/complete Freund's adjuvant (CII/CFA) while the onset and severity of the CIA were monitored. Adipose-derived mesenchymal stromal cells but not fibroblast cells completely suppressed osteoclastogenesis in vitro for human and mice. ADSCs injected after immunization and before of onset of CIA significantly suppressed disease development. Treatment with ADSCs dramatically decreased the levels of NF-κB p65/p50 in osteoclasts in vitro and P65/50 and RANKL expression by synovial tissues in vivo. We have demonstrated that ADSCs can inhibit RANKL-induced osteoclasts genesis via CD39 signals. Our findings also suggest that ADSCs can inhibit osteoclasts genesis without the involvement of regulatory T cells. ADSCs might represent a promising strategy for stem cell-based therapies for RA. Thus, manipulation of ADSCs may have therapeutic effects on RA and other bone erosion–related diseases.     

正常儿童和成人冲突监测及反应抑制能力发展的事件相关电位研究

目的研究不同年龄儿童和成人冲突监测和反应抑制能力的发展变化,探讨非靶-N2(NO-GO-N2)和非靶-P3(NOGO-P3)的神经心理学意义。方法记录和分析18名8岁组和17名11岁组健康儿童及20名22岁组大学生执行持续性操作测试的ERP和行为学结果,分析NOGO-N2和NOGO-P3的发展变化。结果随年龄增长,反应时间[8岁组,11岁组,22岁组分别为(658.01±94.04)ms,(580.14±98.58)ms,(522.21±89.43)ms]缩短,虚报错误数[8岁组,11岁组,22岁组分别为(2.41±2.03)次,(1.30±0.98)次,(0.27±0.59)次]降低,3年龄组间比较差异均有统计学意义(P<0.05)。随年龄增长,击中数增加,遗漏错误数降低,8岁组与11岁组和22岁组比较,差异有统计学意义(P<0.01),11岁组与22岁组比较差异无统计学意义(P>0.05);NOGO-N2波幅显著高于GO刺激的;NOGO-N2波幅随年龄增长,波幅降低,3组间差异均有统计学意义(P<0.05);NOGO-P3波幅在11岁组最低,与8岁组或者22岁组比较差异有统计学意义(P<0.05)。结论NOGO-N2与冲突监测,NOGO-P3与反应抑制有关;注意能力在11岁时发展得比较完善,而冲动抑制能力在11岁后才开始发展;NOGO-N2波幅随年龄增长,波幅降低,而NOGO-P3波幅不存在明显的与年龄相关的变化。     

胸腺五肽对脓毒症致急性肾损伤患者 肾功能的影响

目的 探究讨胸腺五肽对脓毒症引起的急性肾损伤患者肾脏的保护作用。方法 选取2015 年6 月— 2016 年12 月苏州大学附属第三医院脓毒症引发的急性肾损伤患者54 例，随机分为观察组和对照组，每组27 例。对照组患者给予常规治疗，观察组患者在常规治疗的基础上进行胸腺五肽10 mg 皮下注射，1 次/d，持续1 周。结果 两组患者在治疗前TNF-α、IL-10、CRP、PCT 浓度、T 淋巴细胞亚群CD3+、CD4+、CD8+ 细胞及 CD4+/CD8+ 的比值、血肌酐（Scr）和血尿素氮（BUN）浓度的比较差异无统计学意义（P >0.05）；治疗后两组 患者各指标比较差异有统计学意义（P <0.05），观察组患者的CD3+、CD4+、CD8+ 细胞及CD4+/CD8+ 的比值均 高于对照组；TNF-α、IL-10、CRP、PCT、Scr 和BUN 浓度均低于对照组。结论 胸腺五肽可提高和恢复脓 毒症患者的细胞免疫功能，对脓毒症引起的急性肾损伤患者肾脏起到保护作用，具有临床意义。