Motor dysfunction in mild cognitive impairment as tested by kinematic analysis and transcranial magnetic stimulation

ObjectivePrevious studies have demonstrated voluntary movement alterations as well as motor cortex excitability and plasticity changes in patients with mild cognitive impairment (MCI). To investigate the pathophysiology of movement abnormalities in MCI, we tested possible relationships between movement abnormalities and primary motor cortex alterations in patients.MethodsFourteen amnestic MCI (aMCI) patients and 16 healthy controls were studied. Cognitive assessment was performed using clinical scales. Finger tapping was recorded by a motion analysis system. Transcranial magnetic stimulation was used to test the input/output curve of motor evoked potentials, intracortical inhibition, and short-latency afferent inhibition. Primary motor cortex plasticity was probed by theta burst stimulation. We investigated correlations between movement abnormalities, clinical scores, and cortical neurophysiological parameters.ResultsMCI patients showed less rhythmic movement but no other movement abnormalities. Cortical excitability measures were normal in patients, whereas plasticity was reduced. Movement rhythm abnormalities correlated with frontal dysfunction scores.ConclusionOur study in MCI patients demonstrated abnormal voluntary movement and plasticity changes, with no correlation between the two. Altered rhythm correlated with frontal dysfunction.SignificanceOur results contribute to the understanding of pathophysiological mechanisms of motor impairment in MCI.     

多重耐药病原菌对呼吸机相关性肺炎预后的影响

目的探讨多重耐药病原菌对呼吸机相关性肺炎预后的影响。方法选择2012年1月至2018年6月在上海市肺科医院诊断为VAP的382例患者作为研究对象,观察临床资料与预后的相关性。结果382例VAP患者有172例分离出多重耐药菌。多重耐药和非多重耐药患者性别、年龄、原发肺部疾病、VAP类型、诊断前联合应用抗生素、合并心血管疾病和糖尿病、激素应用情况、28d生存状态等因素均存在差异(P<0.05)。多因素Logistic分析显示,其他菌耐药是导致VAP患者死亡的独立危险因素(P<0.05)。结论非发酵革兰阴性杆菌多重耐药不影响VAP患者的28d生存率,其他菌种耐药,是影响VAP患者28d死亡率的危险因素,值得进一步研究。     

Diffusion-weighted MRI and PET/CT reproducibility in epithelial ovarian cancers during neoadjuvant chemotherapy

PurposeTo investigate the reproducibility of diffusion-weighted (DW) MRI and ¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG)-Positron emission tomography/CT (PET/CT) in monitoring response to neoadjuvant chemotherapy in epithelial ovarian cancer.Materials and methodsTen women (median age, 67 years; range: 41.8–77.3 years) with stage IIIC-IV epithelial ovarian cancers were included in this prospective trial (NCT02792959) between 2014 and 2016. All underwent initial laparoscopic staging, four cycles of carboplatine-paclitaxel-based chemotherapy and interval debulking surgery. PET/CT and DW-MRI were performed at baseline (C0), after one cycle (C1) and before surgery (C4). Two nuclear physicians and two radiologists assessed five anatomic sites for the presence of ≥ 1 lesion. Target lesions in each site were defined and their apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV-max), SUV-mean, SUL-peak, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were monitored (i.e., 10 patients × 5 sites × 3 time-points). Their relative early and late changes were calculated. Intra/inter-observer reproducibilities of qualitative and quantitative analysis were estimated with Kappa and intra-class correlation coefficients (ICCs).ResultsFor both modalities, inter- and intra-observer agreement percentages were excellent for initial staging but declined later for DW-MRI, leading to lower Kappa values for inter- and intra-observer variability (0.949 and 1 at C0, vs. 0.633 and 0.643 at C4, respectively) while Kappa values remained > 0.8 for PET/CT. Inter- and intra-observer ICCs were > 0.75 for SUV-max, SUL-peak, SUV-mean and their change regardless the time-point. ADC showed lower ICCs (range: 0.013–0.811). ANOVA found significant influences of the evaluation time, the measurement used (ADC, SUV-max, SUV-mean, SUV-max, SUL-peak, MTV or TLG) and their interaction on ICC values (P = 0.0023, P< 0.0001 and P =0.0028, respectively).ConclusionWhile both modalities demonstrated high reproducibility at baseline, only SUV-max, SUL-peak, SUV-mean and their changes maintained high reproducibility during chemotherapy.     

膳食炎症指数与炎症的相关性及研究进展

膳食炎症指数(DII)来源于将饮食和炎症联系起来的文献,被开发用来量化饮食的整体炎症潜能。饮食在调节慢性炎症中起着核心作用,是重要的调节因子,如果饮食的炎症潜能很高,则能够激发免疫调节作用,引起慢性炎症。DII可用于评估和指导个人饮食计划。本研究收集国外相关文献,就DII与炎症之间的相关性予以综述,以期通过减少饮食中的炎性成分而对慢性炎症引起的相关疾病进行一级预防。     

The endogenous inflammatory reflex inhibits the inflammatory response to different immune challenges in mice

The splanchnic anti-inflammatory pathway, the efferent arm of the endogenous inflammatory reflex, has been shown to suppress the acute inflammatory response of rats to systemic lipopolysaccharide (LPS). Here we show for the first time that this applies also to mice, and that the reflex may be engaged by a range of inflammatory stimuli. Experiments were performed on mice under deep anaesthesia. Half the animals were subjected to bilateral section of the splanchnic sympathetic nerves, to disconnect the splanchnic anti-inflammatory pathway, while the remainder underwent a sham operation. Mice were then challenged intravenously with one of three inflammatory stimuli: the toll-like receptor (TLR)-4 agonist, LPS (60 µg/kg), the TLR-3 agonist Polyinosinic:polycytidylic acid (Poly I:C, 1 mg/kg) or the TLR-2 and -6 agonist dipalmitoyl-S-glyceryl cysteine (Pam2cys, 34 µg/kg). Ninety minutes later, blood was sampled by cardiac puncture for serum cytokine analysis. The splanchnic anti-inflammatory reflex action was assessed by comparing cytokine levels between animals with cut versus those with intact splanchnic nerves. A consistent pattern emerged: Tumor necrosis factor (TNF) levels in response to all three challenges were raised by prior splanchnic nerve section, while levels of the anti-inflammatory cytokine interleukin 10 (IL-10) were reduced. The raised TNF:IL-10 ratio after splanchnic nerve section indicates an enhanced inflammatory state when the reflex is disabled. These findings show for the first time that the inflammatory reflex drives a coordinated anti-inflammatory action also in mice, and demonstrate that its anti-inflammatory action is engaged, in similar fashion, by inflammatory stimuli mimicking a range of bacterial and viral infections.     

Novel variants in aromatic L-amino acid decarboxylase deficiency: Case report of sisters with mild phenotype

BackgroundAromatic L-amino acid decarboxylase (AADC) deficiency, caused by a pathogenic variant in the dopa decarboxylase (DDC) gene, is a rare neurometabolic disorder in which catecholamine and serotonin are not synthesized. From a large number of reports, it has been recognized that most affected patients show severe developmental delay in a bedridden state and are unable to speak. On the other hand, patients with a mild phenotype with AADC deficiency have been reported, but they number only a few cases. Therefore, the variation of phenotypes of the disease appears to be broad, and it may be challenging to diagnose an atypical phenotype as AADC deficiency.Case reportWe report novel compound heterozygous variants in DDC (c.202G > A and c.254C > T) in two sisters, whose main complaint was mild developmental delay, by whole-exome sequencing (WES). Additionally, we describe their clinical features and provide an image that shows the variants located at different sites responsible for the catalysis of AADC in a three-dimensional structure. The patients were prescribed a Monoamine oxidase (MAO) inhibitor after diagnosis.InterpretationOur cases indicate that a comprehensive genomic approach helps to diagnose AADC deficiency with atypical features, and underscore the significance of understanding the variations of this disorder for diagnosis and appropriate treatment.     

Concurrent conventional & high-definition transcranial direct current stimulation for treatment of schizophrenia with co-morbid obsessive-compulsive disorder: A case report

Non-invasive brain stimulation techniques such as conventional transcranial direct current stimulation (tDCS) and high definition tDCS (HD-tDCS) are increasingly being used as add-on treatment options in schizophrenia and obsessive-compulsive disorder (OCD). This is reporting of the use of a novel accelerated, symptom-specific, add-on tDCS (combining conventional and high definition) protocol in a patient with both schizophrenia and OCD. The intervention showed clinical utility by reducing both schizophrenia and OCD symptoms.     

应用 σ度量对深圳市龙华区三家综合医院临床生化检验结果互认的评价研究

目的　探讨 σ度量在深圳市龙华区三家综合医院临床生化检验结果互认中的应用价值。方法　收集三家医院 2019年广东省临检中心常规化学，特殊蛋白前两次的室间质评（ EQA）样本，经混匀并分割成比对样本送至各评价实验室进行检测；以卫生部临检中心（ NCCL)标准和生物学变异导出的允许总误差（ TEa%）为质量规范，通过加权法计算出各项目 2019年 1～ 6月期间室内质控在控数据的不精密度，以 2018年参加卫生部室间质评（ EQA）数据作为偏倚（ bias%）来源，计算三家医院 29个检验项目的 σ度量值并进行性能评价，利用质量目标指数（ QGI)提出改善方法；将评价项目的 σ度量值与直接比对试验进行比较，通过统计分析确定 σ截断值（ cut-off）。结果　①三家医院 29个生化项目的性能并不一致，将项目中、高值的 σ值进行配对 t检验，其 t值分别为 2.28，3.01和 0.74，按 α =0.05水准判断得出医院 A与 B，医院 A与 C间的性能差异有统计学意义，医院 B与 C间的性能差异无统计学意义，医院 A项目性能要优于 B，C医院。评估的 87个项目中有 53项 σ平均值 <6，根据 QGI判断，3个项目需优先改善准确度，10个项目需同步改善准确度和精密度，另 40个项目需优先改善精密度。②对医院间项目比对通过率进行配对 χ2检验，其 χ2分别为 5.33，6.25和 2.5，按α=0.05水准判断， B与 A医院比对通过率低于 C与 A医院、 C与 B医院，差异有统计学意义； C与 A医院比对通过率跟 C与 B医院差异无统计学意义。③将 σ度量值与直接比对试验进行比较，经配对 χ2检验，当 σ cut-off值取≥ 2σ， ≥ 3σ，≥ 4σ，≥ 5σ和≥ 6σ时，其 χ2分别为 7.20，0.00，9.09，15.06和 16.06，按 χ20.05，1=3.84，α=0.05水准判断，当σcut-off值取≥ 3σ时，两种比对方法的差异无统计学意义。结论　σ度量值可以单独用于评价医院间生化检验结果的互认，在判断项目是否具有可比性时，可考虑将 σ cut-off值设为≥ 3σ。