Restless legs syndrome in the elderly.

The prevalence and significance of restless legs syndrome was assessed in 307 patients presenting to an acute-care geriatric medical service. Fifteen patients (5%) had restless legs syndrome; 13 (87%) of these patients had insomnia and 10 (67%) reported troublesome or frequent leg symptoms. Of 147 patients with current insomnia, iron deficiency (serum ferritin < 18 ng/ml) was present in 4/13 (31%) patients with restless legs and 8/134 (6%) patients without restless legs (P < 0.025). Improvement in symptoms of restless legs was noted with iron repletion. These findings suggest that restless legs syndrome is relatively common in the elderly and causes significant discomfort and sleep disturbance. Iron deficiency is a common and treatable cause.     

Nutritional Anemia and Megaloblastosis in Pregnancy

Macrogranulocytic and/or erythroid megaloblastic bone marrow changes which could not be accurately predicted from the hematologic findings in the blood were present in 25% of 305 mildly to moderately anemic pregnant women attending a public antepartum clinic in Montreal. Iron deficiency was the primary cause of anemia in most instances. Serum folate activity of less than 4.1 ng./ml. and/or serum vitamin B₁₂ levels of less than 100 pg./ml. were present in 90% of the 77 patients having these bone marrow changes, whereas approximately one-third of 228 patients with normoblastic marrow had these low values. Red cell folate did not correlate as well as serum folate activity with bone marrow changes. After treatment with oral folic acid in the range of 0.2 mg. to 0.8 mg., daily, for seven to 14 days, the megaloblastic and macrogranulocytic changes in patients with low serum folate activity and normal serum vitamin B₁₂ values disappeared in 15 of 21 patients. Of five women having both low folate and vitamin B₁₂ values, three failed to respond and two showed only partial improvement after 0.4 mg. of folic acid daily, per os, for 10 days. The average diet of these anemic women was suboptimal in folate and in iron.     

Megaloblastic anaemia associated with the oral contraceptive pill

A 27-year-old housewife suffered from severe headaches for a period of 2 years which developed after she started taking an oral contraceptive pill. During this time she gradually developed folic acid deficiency anaemia. This resulted from the inhibition by ‘the pill’ of the intestinal conjugase system required to deconjugate polyglutamic folate. The patient''s headache did not recur after stopping the pill and her anaemia improved with folic acid supplement. The relation between folic acid metabolism and ‘the pill’ is discussed.     

A patient with bulimia nervosa and profound folate deficiency

A case is reported of a young woman with bulimia nervosa who presented with profound folate deficiency. This association has not been reported before despite the increased theoretical possibility. Initially she has responded well to folic acid therapy and social support.     

The Incidence and Prevention of Folate Deficiency in a Pregnant Clinic Population

Non-anemic women attending a public antenatal clinic were given, daily, a multivitamin tablet containing 78 mg. of elemental iron. The follow-up studies included an analysis of their diets. A total of 311 patients were included, of which one group received a supplement of 0.5 mg. folic acid and 0.005 mg. vitamin B₁₂. The incidence of megaloblastic bone marrow change in the unsupplemented group was 26% and of low blood folates approximately 50%. The incidence of megaloblastic changes was sharply reduced in the supplemented group and the blood folates were elevated to supranormal levels, indicating that the dose of folic acid used may have been above the minimal requirement. Formiminoglutamic acid (FIGLU) excretion could not be correlated with other parameters of folate deficiency. Neutrophil lobe counts did not relate to megaloblastic changes or low folate levels unless there was more than 5% hypersegmentation. The dietary intake was suboptimal in total calories, iron and food folate.     

首次急性缺血性卒中患者发病前睡眠障碍的调查

目的 探讨首次急性缺血性卒中患者发病前的睡眠状况.方法 纳入2015年7月至2016年7月在宣武医院神经内科住院的253例首次急性缺血性卒中患者,应用匹兹堡睡眠质量指数量表、Epworth思睡量表、STOP-BANG问卷、不安腿综合征筛查问卷、RBDSQ中文版量表针对患者住院以前有无失眠症状、睡眠呼吸暂停综合征高风险性,有无不安腿综合征,有无快速眼动睡眠期行为障碍(RBD)睡眠情况对患者本人及其家属进行问卷调查.结果 男性患者151例,年龄(68.4±9.4)岁;女性102例,年龄(69.7±9.5)岁.全部患者的匹兹堡睡眠质量指数量表(PSQI)评分为9.0±3.9,STOP-BANG评分为3.9±1.8,两者均高于正常范围.男性患者的STOP-BANG评分以及RBDSQ评分显著高于女性患者.全部患者中,有失眠症状(PSQI≥8分)的患者比例为47.4％(120/253),有日间思睡症状(ESS＞10分)的患者比例为24.5％(62/253),有睡眠呼吸暂停综合征高风险(STOP-BANG问卷＞3分)的患者比例为48.6％(123/253),临床诊断不安腿综合征比例为4.0％ (10/253),有RBD现象(RBDSQ中文版＞5分)的患者比例为7.1％ (18/253).其中男性患者的睡眠呼吸暂停综合征高风险的比例以及有RBD现象的比例显著高于女性患者.结论 首次急性缺血性卒中患者发病前伴有多种睡眠障碍,睡眠呼吸障碍、失眠以及不安腿综合征可能与卒中的发生有一定的相关性.     

Severe thrombocytopenia associated with acute folic acid deficiency and severe hemorrhage in two patients

Severe thrombocytopenia associated with acute folic acid deficiency in two inpatients is described. Both patients had severe hemorrhagic manifestations. A similar syndrome has previously been described in patients who have undergone extensive surgery or dialysis or both. The present cases show that acute folic acid deficiency can occur in other circumstances and may go unrecognized because other signs in the peripheral blood of a megaloblastic process may be minimal. A good response was obtained with folic acid therapy.     

健康成人血浆同型半胱氨酸与叶酸的水平及关系研究

目的了解西宁地区健康人群血浆同型半胱氨酸与叶酸的水平以及二者之间的关系。方法采用荧光偏振免疫分析试剂盒,对西宁地区80例健康人的血浆同型半胱氨酸（Hcy）和叶酸进行检测,同时进行人口学特征及吸烟、饮酒、饮食情况调查。结果研究人群高Hcy血症的检出率较高,为30．7％;血浆Hcy平均水平为10．49μmol／L,年龄越大,血浆Hcy水平越高,男性高于女性。研究对象总的叶酸缺乏率为57．5％,血浆叶酸平均水平为6．62±1．28nmol／L,男性叶酸水平低于女性。血浆叶酸与血浆同型半胱氨酸水平之间存在负相关。两项指标藏汉民族间差异均不显著。结论西宁地区18-24岁健康人群高Hcy血症的检出率及血浆叶酸缺乏率均较高。健康人群血浆Hcy水平与年龄、性别及叶酸水平关系密切。血浆叶酸水平与性别有关。     

Oral methionine loading as a cause of acute serum folate deficiency: its relevance to parenteral nutrition.

Oral methionine supplements (8.0 g daily for 4 days) were given to five normal volunteers who continued to eat their usual diet. This treatment resulted in a significant fall in serum folate concentration. Three days after the end of treatment concentrations had not completely returned to control values. The fall in concentration was prevented by giving oral folic acid supplements. It is suggested that folic acid supplements should be given to patients who are receiving intravenous infusions of amino acid mixtures.     

西宁地区成人血浆叶酸水平研究

目的了解西宁地区成人血浆叶酸水平。方法采用雅培公司的荧光偏振免疫分析试剂盒,对西宁地区80例健康成人的血浆叶酸(FA)水平进行检测,同时进行人口学特征、吸烟、饮酒及饮食情况调查。结果研究人群叶酸缺乏率较高,为57.5%;血浆叶酸平均水平为6.62nmol/L,女性高于男性;年龄、民族对血浆叶酸水平无影响。性别、民族对叶酸缺乏率无影响。结论西宁地区18~24岁健康成人血浆FA水平较低,并以男性为甚;叶酸缺乏率较高。     

Red cell folate concentrations in patients with Crohn's disease on parenteral nutrition

To examine changes in the folate concentrations in red cell during relatively long-term total parenteral nutrition (TPN), 10 Japanese patients with Crohn's disease (7 males), the mean Crohn's disease activity index on admission being 211, were given folic acid in a dose of 400 micrograms/day (AMA-FDA formulation) or 800 micrograms/day for 6-16 weeks (mean 10.5). The red cell folate concentrations were determined before TPN and once every week or 2-4 weeks thereafter. The folate concentrations were very low even after TPN with folic acid of 400 micrograms/day. In those given 800 micrograms of daily folic acid, the folate levels tended to increase, but did not reach the normal range. We propose that folic acid over 800 micrograms/day or a double dose of AMA-FDA formulation should be prescribed for Crohn's disease treated with long-term TPN.     

叶酸干预对复发性流产患者同型半胱氨酸及叶酸水平的影响探讨

目的：探讨叶酸干预对复发性流产患者同型半胱氨酸（HCY）及叶酸水平的影响。方法以42例复发性流产患者为研究对象,45例正常孕前检查者为对照,检测2组血清HCY水平、叶酸水平,根据检查结果给予叶酸干预,比较干预后2组HCY、叶酸水平。结果入组时复发性流产组血清HCY、血浆叶酸及红细胞叶酸水平与对照组比较差异均有统计学意义（P<0.05）。用药3个月后,复发性流产组血清HCY水平仍然显著高于对照组（P<0.05）,红细胞叶酸水平显著低于对照组（P<0.05）,但是血浆叶酸水平接近对照组,差异无统计学意义（P>0.05）。结论复发性流产患者血清同型半胱氨酸水平高于正常女性,叶酸水平偏低,叶酸干预可改善患者叶酸代谢紊乱、降低同型半胱氨酸水平。     

The aetiology of severe anaemia among antenatal patients of the Port Moresby General Hospital

Between October 1998 and September 2000, 111 consecutive pregnant patients admitted to the Port Moresby General Hospital antenatal ward with a haemoglobin level of 6 g/dl or less were studied. The main causes of the severe anaemia were as follows: iron deficiency on its own or in combination with another factor 66%--iron deficiency on its own 43% and combined folate and iron deficiency 23%--and folate deficiency 18%. Malaria was a contributory factor in 13 patients (12%). A combination of blood film, bone marrow study, serum assays of ferritin, folate and vitamin B12, and mean corpuscular volume (MCV) was used to determine the cause of the anaemia. Ferritin levels on their own poorly correlated with the presence of iron in the bone marrow. A low MCV correlated well with iron deficiency anaemia while a high MCV was associated with folic acid deficiency. It would seem therefore that while a bone marrow study is mandatory to reach a definitive diagnosis of severe anaemia, MCV, in conjunction with the red cell morphology on blood film, would be a good marker for iron and folic acid deficiency anaemia, especially as we do not have serum assays readily available for folate, ferritin and vitamin B12 in Papua New Guinea.     

维持性血液透析患者微炎症状态与睡眠障碍的关系探讨

目的通过对血液透析中心患者睡眠障碍的调查,探讨规律血液透析患者的失眠率及与微炎症状态的关系。方法以126例透析龄≥6个月的患者为研究对象,分别采用阿森斯失眠量表(AIS)、不宁腿诊断标准量表进行评估,同时记录患者检验指标(铁蛋白、血红蛋白、尿素氮、肌酐、甲状旁腺素、C-反应蛋白),并以AIS=6为界值,将患者分为失眠和非失眠两组,对两组进行相关性分析。结果失眠患者占总人数的30.18%;失眠组患者体内CRP水平明显升高,两组相比差异有统计学意义(P<0.05),其余指标差异均无统计学意义。结论维持性血液透析患者的失眠率为30.18%;血液透析患者微炎症状态与睡眠障碍密切相关,患者微炎症状态的存在可能是睡眠障碍发生的原因之一。     

Megaloblastic anemia in patients receiving total parenteral nutrition without folic acid or vitamin B12 supplementation.

Pancytopenia developed in four patients receiving postoperatively total parenteral nutrition (TPN). Symptoms and signs were related mainly to underlying bowel disease. Hematologic abnormalities, first noted from 4 to 7 weeks following institution of TPN, consisted of normocytic anemia (mean decrease in hemoglobin value, 2.2 g/dL), occasional macrocytes being noted, leukopenia (range of leukocyte counts, 1.2 to 3.6 X 10(9) L), some hypersegmented neutrophils being detected, and clinically significant thrombocytopenia (range of platelet counts, 25 to 52 X 10(9)/L). In all patients the bone marrow showed megaloblastic changes, with ring sideroblasts, although pyridoxine was included in the TPN regimens. Serum vitamin B12 values were normal in one patient and at the lower limit of normal in the other two patients in whom it was measured, while serum or erythrocyte folate values, or both, were reduced in three patients. Full hematologic response was observed in the four patients after folic acid replacement therapy; leukocytosis and thrombocytosis were noted in three. Thus, folic acid and possibly vitamin B12 should be added routinely to TPN regimens to prevent deficiency of either substance.     

Pteridines and mono-amines: relevance to neurological damage

Patients with phenylalanine hydroxylase deficiency show increased concentrations of biopterins and neopterins, and reduced concentrations of serotonin and catecholamines, when phenylalanine concentrations are raised. The pterin rise reflects increased synthesis of dihydroneopterin and tetrahydrobiopterin, and the amine fall a reduction in amine synthesis due to inhibition by phenylalanine of tyrosine and tryptophan transport into neurones. The pterin and amine changes appear to be independent of each other and are present in the central nervous system as well as the periphery; they disappear when phenylalanine concentrations are reduced to normal. Patients with arginase deficiency show a similar amine disturbance but have normal pterin levels. The amine changes probably contribute neurological symptoms but pterin disturbance is not known to affect brain function. Patients with defective biopterin metabolism exhibit severely impaired amine synthesis due to tetrahydrobiopterin deficiency. Pterin concentrations vary with the site of the defect. Symptoms include profound hypokinesis and other features of basal ganglia disease. Neither symptoms nor amine changes are relieved by controlling phenylalanine concentrations. Patients with dihydropteridine reductase (DHPR) deficiency accumulate dihydrobiopterins and develop secondary folate deficiency which resembles that occurring in patients with defective 5,10-methylene tetrahydrofolate reductase activity. The latter disorder is also associated with Parkinsonism and defective amine and pterin turnover in the central nervous system, and a demyelinating illness occurs in both disorders. In DHPR deficiency cerebral calcification may develop in a similar distribution to that seen in congenital folate malabsorption and methotrexate toxicity. Symptoms are ameliorated by therapy with 5-formyltetrahydrofolate but exacerbated by folic acid.     

Restless legs syndrome: literature review

Restless legs syndrome is a distressing condition, with negative effects on sleep and daytime activities that affect personal, family and occupational life. The overall impact of restless legs syndrome on quality of life is comparable to that of chronic and frustrating conditions such as depression and diabetes. Misdiagnosis and inappropriate treatment may increase patients' suffering in terms of uncertainty, overuse or misuse of care services and lack of trust. Presenting a synthesis of the main topics in the literature on restless legs syndrome facilitates for a better understanding and its management in primary care settings.     

基于《黄帝内经》营卫理论探讨不安腿综合征

基于《黄帝内经》(《内经》)理论,分析不安腿综合征的临床特点,认为本病与中医学肉苛、肉烁、足悗等病证有关;运用营卫运行节律分析,本病基本病机为营卫失和,气血不调;其病位在筋肉,故责之肝脾不调.不安腿综合征病因复杂,病情迁延难愈,符合《内经》"因加而发,合邪为患"的发病观,即外感风寒湿邪,内有营卫气血失和与肝脾功能失调,...     

"Folate before pregnancy": the impact on women and health professionals of a population-based health promotion campaign in South Australia

OBJECTIVES: To evaluate a South Australian campaign to promote and implement knowledge that taking adequate folate/folic acid in the periconceptional period can reduce the risk of having a baby with a neural tube defect. DESIGN AND SETTING: The campaign, conducted in October 1994--August 1995, targeted women of reproductive age and health professionals. Evaluation was by computer-assisted telephone interviews undertaken by random dialling throughout the State before and after the campaign, and by self-administered questionnaires to health professionals and women in the postnatal period. PARTICIPANTS: Women of reproductive age and four groups of health professionals. MAIN OUTCOME MEASURES: Knowledge about folate, folate-rich foods and the periconceptional period; participation of health professionals in advising women about folate; use of periconceptional folic acid supplements; sales of folic acid tablets; and prevalence of neural tube defects. RESULTS: Significant increases in knowledge about folate followed the campaign. Health professionals and women in the postnatal period had higher initial levels of knowledge about folate, which also increased significantly. The proportions of women taking periconceptional folic acid supplements, and of health professionals advising women planning a pregnancy about folate, also increased significantly, and folic acid tablet sales doubled. Total prevalence of neural tube defects declined between 1966 and 1999 from a baseline of 2.0 per 1,000 births to 1.1 per 1,000 births (Poisson regression, P= 0.03; average decline of 1.0% per year). CONCLUSIONS: A short educational campaign with a limited budget ($40,000) can promote folate successfully, but alternative strategies such as food fortification are likely to be needed to achieve adequate periconceptional folate intake for a very high proportion of women.     

维持性血液透析并不宁腿综合征26例治疗观察

目的 探讨右旋糖酐铁对维持性血液透析患者并发不宁腿综合征(restless legs syndrome,RLS)的治疗效果.方法 将26例慢性肾衰竭维持性血液透析患者随机分为两组,试验组在常规透析基础上口服左旋多巴100mg,睡前2小时口服,右旋糖酐铁50mg,每天3次,饭后口服;对照组在常规透析基础上仅口服左旋多巴1...