帕金森病伴发轻度认知障碍患者血浆磷脂分子含量变化及意义

目的：分析探讨帕金森病伴发轻度认知障碍患者血浆磷脂分子含量变化和意义。方法选择2012年3月-2014年3月该院治疗的帕金森病伴发轻度认知障碍患者50例,并选择同期在该院健康体检的50例和帕金森病无认知障碍的50例分别作为对照组A和对照组月,测定三组研究对象的血浆磷脂含量,并评定研究对象的智能状态,分析研究对象智能状态与血浆磷脂含量之间的关系。结果观察组MMSE得分、CDT得分以及MoCA得分均明显低于对照组A和对照组月(P<0.01);观察组的磷脂分子含量明显高于对照组A和对照组B(P<0.01);两组之间各项指标差异无统计学意义(P>0.05)。结论帕金森病伴发轻度认知障碍患者细胞膜受到了严重的损伤,血浆磷脂分子可作为新生物标记物,通过其含量变化可判断认知功能受损情况。     

婴幼儿心力衰竭血浆氨基末端B型利钠肽前体检测及诊断截断点的探讨

目的:对婴幼儿心力衰竭血浆氨基末端B型利钠肽前体检测(NT-proBNP)的价值及诊断截断点进行探讨,为临床诊断提供指导.方法:选取2012年6月～2014年6月间佛山市顺德区妇幼保健院诊治的心力衰竭患者及体检的健康人员各76例为研究对象,分为观察和对照组.所有研究对象行NT-proBNP及心脏射血指数(LVEF)检测,并进行组间比较.观察组患者采用改良Ross标准进行评价,并按照分级对NT-proBNP结果进行比较.同时采用ROC曲线对观察组研究对象检测的敏感性、特异性及诊断截断点予以分析,并就婴幼儿及成人进行组间比较及数据分析.结果:观察者组研究对象中成年人、婴幼儿及平均NT-proBNP含量分别为(1 325.5±148.8)、(3 106.4±593.9)、(2 548.7±368.2)ng/L,均高于对照组(P＜0.05);对两组研究对象的NT-proBNP及LVEF进行组间比较,均具有统计学差异(P＜0.05);观察组在轻、中、重3个级别的NT proBNP含量比较有统计学差异(P＜0.05);组内按年龄组比较,婴幼儿NT-proBNP含量高于成年,且具有统计学差异(P＜0.05);根据ROC曲线分析得出婴幼儿心衰阳性的NT-proBNP参考指标为500ng/L.结论:血浆氨基末端B型利钠肽前体检测在心力衰竭诊断中具有重要的价值,且婴幼儿与成人患者的诊断截断点存在差异,可以500 ng/L作为婴幼儿心衰诊断的参考值.     

整体护理干预应用于血栓性血小板减少性紫癜患者实施血浆置换期间的临床研究

目的：探讨整体护理干预应用于血栓性血小板减少性紫癜（TTP）患者实施血浆置换期间的临床效果。方法选择收治的 TTP 患者58例作为研究对象,将2009年5月—2011年4月实施常规护理的27例患者作为对照组,将2011年5月—2014年4月实施整体护理的31例患者作为观察组,比较二组患者护理前后的汉密尔顿焦虑量表（HAMA）和焦虑自评量表（SAS）评分、不良反应发生率及患者满意度。结果观察组出院前1d HAMA 、SAS 评分为（14．19±1．39）分和（35．27±8．57）分,均低于对照组,差异有统计学意义（P＜0．05）;观察组护理质量、护理满意度评分为（9．48±0．34）分和（9．56±0．28）分,均高于对照组,差异有统计学意义（ P ＜0．05）;观察组不良反应发生率显著低于对照组,差异有统计学意义（ P ＜0．05）。结论 TTP 患者实施血浆置换期间应用整体护理干预显著缓解焦虑情绪,提高了患者满意度,值得临床重视。     

Electroconvulsive therapy (ECT) and aerobic exercise training (AET) increased plasma BDNF and ameliorated depressive symptoms in patients suffering from major depressive disorder

BackgroundTo treat patients suffering from major depressive disorder (MDD), research has focused on electroconvulsive therapy (ECT) and aerobic exercise training (AET). Brain derived neurotrophic factor (BDNF) seems to be key in MDD. The aims of the present study were therefore two-fold, to investigate in a three-arm interventional study the differential effects of ECT, ECT plus AET, and AET alone in patients suffering from TR-MDD on 1. depressive symptoms and 2. plasma BDNF (pBDNF).Methods60 patients with MDD (mean age: 31 years; 31.6% female patients) were randomly assigned either to the ECT, ECT + AET, or AET condition. The AET condition consisted of treadmill exercise for 45 min, three times a week. Both depression severity and pBDNF levels were assessed at baseline and 4 weeks later. All patients were further treated with an SSRI standard medication.ResultspBDNF levels increased over time in all three study conditions, though, highest increase was observed in the ECT + EAT condition, and lowest increase was observed in the AET condition. Depressive symptoms decreased in all three conditions over time, though, strongest decrease was observed in the ECT + AET condition. The combination of ECT + AET led to significantly greater remission rates than in either the ECT or AET alone conditions. BDNF levels were not associated with symptoms of depression.ConclusionsThe pattern of results suggests that ECT, AET and particularly their combination are promising directions for the treatment of patients suffering from MDD, and that it remains unclear to what extent pBDNF is key and a reliable biomarker for MDD.     

血浆粘度与小动脉闭塞型脑梗死的相关性究

目的研究血浆粘度(PV)与急性脑梗死及不同卒中亚型之间的关系。方法收集2013年8月至2014年8月在河北省人民医院院神经内科被诊断为急性脑梗死的住院患者,入选120例,分为大动脉粥样硬化组(n=44)、小动脉闭塞组(n=40)、心源性脑栓塞组(n=36),以血浆粘度作为研究变量。结果分析发现急性脑梗死患者血浆粘度[1.36(1.35~1.38)]和无缺血性卒中患者的血浆粘度[1.32(1.27~1.34)]相比显著增高(P0.05)。小动脉闭塞型卒中患者的血浆粘度[1.42(1.39~1.45)]和大动脉粥样硬化组[1.33(1.31~1.35)]以及心源性脑栓塞组[1.35(1.33~1.37)]相比显著增高(P0.05)。而且血浆粘度的增高与小动脉闭塞型脑梗死的发生密切相关(OR=6.33)。结论急性缺血性卒中患者血浆粘度明显增高且血浆粘度增高与小动脉闭塞型脑梗死密切相关,可能在小动脉闭塞型脑梗死发生和发展中发挥重要作用。     

Role of cell-free DNA for predicting incidence and outcome of patients with ischemic stroke

Early diagnosis and prognosis of ischemic stroke remains a critical challenge in clinical settings. A blood biomarker can be a promising quantitative tool to represent the clinical manifestations in ischemic stroke. Cell-free DNA (cfDNA) has recently turned out to be a popular circulating biomarker due to its potential relevance for diagnostic applications in a variety of disorders. Despite bright outlook of cfDNA in clinical applications, very less is known about its origin, composition, or function. Several recent studies have identified cell-derived mitochondrial components including mitochondrial DNA (mtDNA) in the extracellular spaces including blood and cerebrospinal fluid. However, the time course of alterations in plasma mtDNA concentrations in patients after an ischemic stroke is poorly understood. DNA is thought to be freed into the plasma shortly after the commencement of an ischemic stroke and then gradually decreased. However, the importance of cell-free mtDNA (cf-mtDNA) in ischemic stroke is still unknown. This review summarizes about the utility of biomarkers which has been standardized in clinical settings and role of cfDNA including cf-mtDNA as a non-invasive potential biomarker of ischemic stroke.     

循经针刺对偏头痛的即刻疗效及其机制探讨

目的:观察循经针刺治疗偏头痛患者的即可疗效,并通过检测降钙素基因相关肽(CGRP)、血浆内皮素(ET)和五羟色胺(5-HT)的表达情况探讨其机制。方法:选取2017年2月至2018年2月天津中医药大学附属武清中医院收治的偏头痛患者85例作为研究对象,根据随机数字表法将患者分为观察组(n=43)和对照组(n=40),排除不良反应的5例,2组均为40例,观察组予以循经针刺法针刺少阳经的角孙、风池、外关、阳陵泉和丘墟穴,对照组予以非经非穴治疗。于治疗前及治疗后0. 5、1、2和4 h进行偏头痛积分和VAS(视觉模拟量表评分)评估;采用放射免疫法检测降钙素基因相关肽(CGRP)和血浆内皮素(ET),利用ELISA(酶联免疫吸附剂测定)检测五羟色胺(5-HT),观察2组患者治疗前和治疗后4 h的表达情况,探讨循经针刺的疗效机制。记录研究过程中存在的不良反应。结果:1)观察组循经针刺对偏头痛的临床有效率是90. 00%,对照组是67. 50%,观察组的临床有效率优于对照组,2组比较差异有统计学意义(P 0. 05)。2) 2组治疗后0. 5、1、2和4 h的偏头痛积分和VAS评分均较治疗前下降(P 0. 05),仅治疗后2 h及治疗后4 h的偏头痛积分和VAS评分较对照组低(P 0. 05)。3) 2组治疗前CGRP和ET的表达差异无统计学意义(P 0. 05);与治疗前比较,2组治疗4 h后均可下调CGRP和ET的表达水平(P 0. 05);观察组治疗后CGRP和ET的下调水平优于对照组(P 0. 05)。4) 2组治疗前5-HT的表达无比较,差异统计学异议(P 0. 05);与治疗前比较,2组治疗4 h后均上调5-HT的表达水平(P 0. 05),其中观察组优于对照组(P 0. 05)。5)研究过程中5例患者出现不良反应,其中观察组出现3例(晕针2例+局部出血1例),对照组2例(晕针1例+局部出血1例)。晕针患者平卧取针后即可恢复,局部出血则以局部按压进行止血处理。整个研究过程中均未出现严重不良反应。结论:循经针刺治疗偏头痛患者的即刻疗效于治疗后0. 5 h症状开始缓解,于治疗后4 h疗效最佳,其即刻疗效可能与上调CGRP和5-HT表达水平和下调ET表达水平有关。     

Evolving Role of Daratumumab: From Backbencher to Frontline Agent

Approval of daratumumab (DARA), an IgGk1 monoclonal antibody targeting CD38, for the treatment of relapsed/refractory multiple myeloma as monotherapy in November 2015 expanded the therapeutic armamentarium for multiple myeloma. Widespread tissue expression of CD38 combined with potent immunomodulatory activity provides a rationale for the expanding use of DARA and potential new marketing authorizations. Novel combinations of DARA have been built on the basis of preclinical data of synergy and overcoming DARA resistance. Newer delivery strategies have led to the administration of DARA in community settings. Despite a remarkable tolerability profile in elderly myeloma patients, DARA use increases the risk of infections, particularly virus reactivation, requiring close monitoring and/or prophylaxis. We aim to provide an in-depth review of the mechanisms of action, resistance, and synergies of DARA and to highlight its current clinical uses and potential future perspectives. Laboratory issues with the use of DARA and their mitigation strategies are also discussed.