人参皂苷Rg1对帕金森病小鼠中脑黑质神经调节蛋白1-ErbB4信号通路活性的影响

目的探讨人参皂苷Rg1对帕金森病(PD)小鼠中脑黑质中神经调节蛋白1(NRG1)-Erb B4信号通路活性的影响。方法将40只C57BL/6小鼠随机分为生理盐水对照组、1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)模型组、MPTP+Rg1组、MPTP+Rg1+N-[2-(P-溴苯丙烯盐基氨基)乙基]-5-异喹啉磺酰胺(H89)组。在注射MPTP前3 d,生理盐水对照组、MPTP模型组小鼠腹腔注射生理盐水1 m L·kg-1·d-1,MPTP+Rg1组、MPTP+Rg1+H89组小鼠腹腔注射人参皂苷Rg1 10 mg·kg-1·d-1,连续4 d,第4天在注射完人参皂苷2 h后,MPTP模型组、MPTP+Rg1组、MPTP+Rg1+H89组小鼠腹腔注射MPTP 20 mg·kg-1,均注射4次,每次间隔2 h,而MPTP+Rg1+H89组在首次注射MPTP前30 min腹腔注射H89 1 mg·kg-1。药物注射后连续7 d观察小鼠行为学变化,采用反转录多聚酶链反应(RT-PCR)检测小鼠中脑黑质中Nrg1与Erb B4基因的mRNA表达情况,采用Western blot检测NRG1受体Erb B4蛋白及磷酸化Erb B4(p-Erb B4)蛋白的表达及其磷酸化水平。结果 MPTP模型组小鼠中脑黑质内Nrg1基因mRNA表达水平低于生理盐水对照组(P=0.007 9)和MPTP+Rg1组(P=0.004 9);MPTP+Rg1+H89组与MPTP模型组相比,Nrg1 mRNA表达水平差异无统计学意义(P=0.151 3);MPTP+Rg1+H89组与MPTP+Rg1组比较,小鼠中脑黑质内Nrg1 mRNA表达水平降低(P=0.049 3)。MPTP模型组小鼠中脑黑质内的Nrg1-typeⅠ/Ⅱ的mRNA表达水平显著低于生理盐水对照组(P=0.001 9)和MPTP+Rg1组(P=0.043 2);MPTP+Rg1+H89组与MPTP模型组小鼠中脑黑质内Nrg1-typeⅠ/ⅡmRNA表达水平比较差异无统计学意义(P=0.688 5);MPTP+Rg1+H89组与MPTP+Rg1组比较,小鼠中脑黑质内Nrg1-typeⅠ/ⅡmRNA表达显著下降(P=0.029 4)。与生理盐水对照组相比,Nrg1-typeⅢmRNA在MPTP组略有降低,但差异无统计学意义(P=0.290 8);与MPTP模型组比较,MPTP+Rg1组小鼠中脑黑质内Nrg1-typeⅢmRNA表达升高(P=0.041 9),MPTP+Rg1+H89组小鼠黑质Nrg1-typeⅢmRNA表达降低(P=0.728 9);MPTP+Rg1+H89组与MPTP+Rg1组小鼠黑质Nrg1-typeⅢmRNA表达比较差异无统计学意义(P=0.164 2)。生理盐水对照组、MPTP模型组、MPTP+Rg1组、MPTP+Rg1+H89组小鼠黑质Erb B4 mRNA表达水平比较差异均无统计学意义(P=0.531 8)。各组小鼠中脑黑质内Erb B4蛋白表达水平比较差异均无统计学意义(P=0.800 5);MPTP模型组小鼠黑质内p-Erb B4蛋白表达水平低于生理盐水对照组(P=0.013 4)和MPTP+Rg1组(P=0.019 9);MPTP+Rg1+H89组p-Erb B4蛋白表达水平低于MPTP+Rg1组(P=0.047 8);MPTP+Rg1+H89组与MPTP模型组p-Erb B4表达水平比较差异无统计学意义(P=0.887 7)。结论 PD小鼠脑内的NRG1基因表达及其Erb B4受体的活性降低,而人参皂苷Rg1可能通过增强小鼠中脑黑质NRG1-Erb B4的通路活性而改善PD的症状。     

人参皂苷Rg1对1-甲基-4-苯基-1,2,3,6-四氢吡啶诱导的帕金森病小鼠黑质酪氨酸蛋白激酶A4表达的影响

目的探讨人参皂苷Rg1对帕金森病(PD)小鼠黑质中酪氨酸蛋白激酶A4(Eph A4)表达的影响及意义。方法将45只C57BL/6小鼠随机分为正常对照组、模型组、人参皂苷Rg1组、1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)+人参皂苷Rg1+9-(四氢-2-呋喃基)-9H-嘌呤-6-胺(SQ22536)组和MPTP+人参皂苷Rg1+N-[2-(P-溴苯丙烯盐基氨基)乙基]-5-异喹啉磺酰胺(H-89)组。正常对照组和模型组小鼠腹腔注射生理盐水,其他各组小鼠腹腔注射人参皂苷Rg1预防给药,腹腔注射MPTP构建PD模型,MPTP+人参皂苷Rg1+SQ22536组和MPTP+人参皂苷Rg1+H-89组在注射MPTP前30 min分别注射SQ22536和H-89。采用反转录-聚合酶链反应和Western blot检测小鼠黑质Eph A4 mRNA和蛋白表达水平。结果模型组、人参皂苷Rg1组、MPTP+人参皂苷Rg1+SQ22536组和MPTP+人参皂苷Rg1+H-89组小鼠黑质Eph A4 mRNA表达水平显著高于正常对照组(P<0.01,P<0.05),但人参皂苷Rg1组、MPTP+人参皂苷Rg1+SQ22536组和MPTP+人参皂苷Rg1+H-89组小鼠黑质Eph A4 mRNA表达水平显著低于模型组(P<0.01);MPTP+人参皂苷Rg1+SQ22536组和MPTP+人参皂苷Rg1+H-89组小鼠黑质Eph A4 mRNA表达水平显著高于人参皂苷Rg1组(P<0.01)。模型组、人参皂苷Rg1组、MPTP+人参皂苷Rg1+SQ22536组和MPTP+人参皂苷Rg1+H-89组小鼠黑质Eph A4蛋白表达水平显著高于正常对照组(P<0.01),但人参皂苷Rg1组、MPTP+人参皂苷Rg1+SQ22536组和MPTP+人参皂苷Rg1+H-89组小鼠黑质Eph A4蛋白表达水平显著低于模型组(P<0.01,P<0.05);MPTP+人参皂苷Rg1+SQ22536组和MPTP+人参皂苷Rg1+H-89组小鼠黑质Eph A4蛋白表达水平显著高于人参皂苷Rg1组(P<0.01,P<0.05)。结论 MPTP可能通过促进小鼠中脑黑质区Eph A4的表达导致PD发生;人参皂苷Rg1可能通过活化腺苷酸环化酶/环磷酸腺苷/蛋白激酶A信号转导通路,降低PD小鼠黑质区Eph A4的表达而改善PD症状。     

HO-1对帕金森病模型小鼠多巴胺能神经元的作用

目的探讨抑制血红素加氧酶-1(HO-1)对1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)致帕金森病小鼠模型黑质多巴胺能神经元的作用。方法 C57BL/6小鼠随机分为对照组、MPTP组及锌原卟啉(ZnPPIX)+MPTP组,每组6只。腹腔注射MPTP(30mg/kg)5d制备帕金森病小鼠模型,MPTP组于MPTP注射前4d行侧脑室注射9g/L氯化钠溶液2μL,连续8d;ZnPPIX+MPTP组于MPTP注射前4d行侧脑室微注射ZnPPIX(50μg/kg)2μL,共8d;对照组以等量的9g/L氯化钠溶液取代ZnPPIX和MPTP。应用Western blots法检测黑质内HO-1和酪氨酸羟化酶(TH)的表达水平。结果 ZnPPIX+MPTP组小鼠黑质内HO-1表达明显低于对照组和MPTP组,差异有显著性(F=6.844,q=5.943、4.444,P<0.05);MPTP组、ZnPPIX+MPTP组黑质区TH表达较对照组明显下降(F=5.095,q=4.303、4.030,P<0.05),ZnPPIX+MPTP组小鼠TH表达量与MPTP组比较差异无显著性(q=0.234,P>0.05)。结论抑制HO-1表达对MPTP致帕金森病小鼠黑质内多巴胺能神经元的损伤无明显作用。     

丰富环境对MPTP致快速老化小鼠脑损伤的干预效应

[摘要]目的观察丰富环境(EE)对快速老化(SAMP8)小鼠黑质脑源性神经营养因子(BDNF)的影响,探讨EE保护黑质多巴胺神经元降低1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)损伤的机制。 方法80只3个月龄雌性SAMP8小鼠随机分为EE组和标准环境组(SE组)。饲养3个月后,EE组和SE组小鼠分别随机分为MPTP组和生理盐水对照组(NS组),每组20只。 MPTP组小鼠皮下注射MPTP(14 mg/kg每2 h一次,共4次),NS组小鼠皮下注射等量的生理盐水。第7天取鼠脑采用RT-PCR方法观测黑质BDNF mRNA,免疫组织化学方法观察黑质BDNF 免疫反应性的表达。 结果EE+NS组与SE+NS组比较,黑质BDNF mRNA表达增加(P<0.01);黑质区BDNF-ir阳性细胞数及矫正光密度(COD)值均增加(P<0.01)。SE+MPTP组与SE+NS组比较,黑质 BDNF mRNA表达下降(P<0.001);黑质区BDNF-ir阳性细胞数及COD值均下降(P<0.01)。EE+MPTP组与SE+MPTP组比较,黑质BDNF mRNA表达增加(P<0.01);黑质区BDNF-ir阳性细胞数及COD值均增加(P<0.01)。结论EE能增加SAMP8小鼠黑质区BDNF mRNA及BDNF-ir的阳性表达,降低MPTP对SAMP8小鼠黑质的损伤,对黑质有保护作用。     

TLR4抗体对MPTP诱导的亚急性帕金森病小鼠的神经保护作用

目的 研究Toll样受体4(Toll-like receptor 4,TLR4)单克隆抗体对1-甲基-4-苯基-1,2,3,6-四氢吡啶(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine,MPTP)诱导的帕金森病(Parkinson's disease,PD)模型小鼠的神经保护作用.方法 将48只C57BL/6J雄性小鼠随机分为对照组、MPTP组和TLR4抗体+MPTP组,每组16只.连续7天腹腔注射MPTP制作亚急性PD小鼠模型.用小鼠滚筒协调运动测试仪评价小鼠的运动协调能力,记录运动跌落潜伏期,免疫组织化学法检测各组小鼠中脑酪氨酸羟化酶(tyrosine hydroxylase,TH)(+)多巴胺能神经元、TLR4(+)细胞及CD11b(+)小胶质细胞的表达情况,显微镜观察载玻片并拍照,用Image Pro Plus图像处理软件进行细胞计数并比较各组间的差异.结果 3组小鼠中脑TH(+)多巴胺能神经元计数、TLR4(+)细胞数目和CD11b(+)细胞数目差异具有统计学意义(P均<0.001),对照组小鼠TH(+)多巴胺能神经元数目最多,MPTP组多巴胺能神经元数目最少,TLR4抗体+MPTP组居中;MPTP组小鼠TLR4(+)细胞数目和CD11b(+)细胞数目最多,TLR4抗体+MPTP组次之,对照组最少,组间比较差异有统计学意义(P均<0.001).结论 TLR4特异性抗体可逆转MPTP造成的小胶质细胞激活和多巴胺能神经元损伤,是临床PD治疗方案的新选择.     

线粒体丝氨酸蛋白酶抑制MPTP诱导小鼠帕金森病的研究

目的 探讨线粒体丝氨酸蛋白酶(HtrA2/Omi)对1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)诱导的帕金森病(PD)模型小鼠中脑多巴胺能神经元的影响.方法 12月龄C57BL雄性小鼠随机分为生理盐水组(5只)、MPTP组(5只)和MPTP+HtrA2/Omi组(6只),MPTP+HtrA2/Omi组小鼠尾静脉注射腺相关病毒AAV9-HtrA2/Omi表达HtrA2/Omi.腺相关病毒AAV9-HtrA2/Omi注射2周后,MPTP组和MPTP+HtrA2/Omi组1次/d,连续2周腹腔注射MPTP构建PD小鼠模型,生理盐水组注射等量生理盐水.在MPTP注射前1周及注射后第1、2周对3组小鼠进行爬杆实验和转棒实验.在M PT P注射结束后,检测3组小鼠脑组织绿色荧光蛋白(GFP),检测HtrA2/Omi过表达情况;组织切片酪氨酸羟化酶(TH)免疫荧光检测中脑多巴胺能神经元;蛋白免疫印迹检测TH蛋白表达量;组织免疫荧光检测α突触核蛋白聚集.结果 MPTP导致小鼠出现行为学功能障碍,成功构建PD小鼠模型.过表达HtrA2/Omi可减轻因MPTP导致的多巴胺能神经元减少,减轻α突触核蛋白聚集,改善小鼠行为功能障碍.结论 过表达HtrA2/Omi可改善MPTP所致小鼠的PD症状.     

异钩藤碱对MPTP所致帕金森病小鼠的疗效研究

目的:研究钩藤提取物异钩藤碱(IsoRhy)对1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)诱导的帕金森病(PD)模型小鼠的神经保护作用.方法:将C57BL/6小鼠随机分为对照组、MPTP组、雷沙吉兰(Rasagiline,0.1 mg/kg)组和IsoRhy(40 mg/kg)组,每组8只.除对照组外,其他...     

侧脑室注射orexin B对MPTP帕金森病模型小鼠运动行为影响

目的 探究侧脑室注射orexin B对1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)帕金森病模型小鼠运动行为的影响.方法 将小鼠随机分为正常对照组、MPTP组、orexin B组和orexin B+MPTP组.采用转棒实验观察各组小鼠在旋转棒上停留的时间.结果 与正常对照组相比,MPTP组小鼠在旋转棒上停留的...     

MPTP诱导PD小鼠黑质及前额叶皮质铁相关蛋白表达变化

目的 研究1-甲基-4-苯基-1,2,3,6-四氢吡啶(MPTP)诱导的帕金森病(PD)小鼠模型黑质(SN)及内侧前额叶皮质(mPFC)铁代谢相关蛋白的表达变化.方法 将12只9周龄C57BL/6J雄性小鼠随机分为对照组和MPTP组.对照组小鼠给予生理盐水腹腔注射,MPTP组小鼠给予MPTP 30 mg/kg腹腔注射,...     

GDNF基因修饰的NSCs联合EPO通过Nrf2-COX2/iNOS保护帕金森小鼠神经功能

目的 探讨胶质细胞源性神经营养因子（glial cell line-derived neurotrophic factor,GDNF）修饰的神经干细胞（neural stem cells,NSCs）联合促红细胞生成素（erythropoietin,EPO）对1-甲基-4-苯基-1,2,3,6-四氢吡啶（1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine,MPTP）诱导帕金森小鼠的神经保护作用。方法 C57BL/6雄性小鼠分为Normal组、Sham组、MPTP组、Sham+EPO组、Sham+GDNF-NSCs组、MPTP+EPO组、MPTP+GDNF-NSCs组和MPTP+GDNF-NSCs+EPO组。MPTP腹腔注射诱导建模后分别进行腹腔EPO注射、双侧纹状体移植GDNF-NSCs或者两者同时干预,Sham组在纹状体注射等体积生理盐水。在建模第7、14、28和42 d时检测行为学变化、纹状体多巴胺含量、线粒体膜电位及荧光定量PCR检测细胞内关键抗氧化蛋白NF-E2相关因子2(Nrf2)、环氧合酶2(COX2)和诱导型一氧化氮合酶（iNOS）基因...     

Mechanisms of Electroacupuncture on Alzheimer's Disease: A Review of Animal Studies

Alzheimer's disease(AD) is the main type of dementia affecting elderly people. The medicines used for treating AD have limits in their ability to alleviate cognitive and functional decline. Electroacupuncture(EA), an economical alternative and complementary therapeutic measure used in Chinese medicine, has strong clinical applicability, and its treatment effects are more reliable as its stimulation factors can be standardized. EA has been effectively used for ameliorating spatial learning and memory impairment in AD patients and rodent AD models. Here, we summarized the mechanisms of EA on rodent AD models, aiming to provide a theoretical basis for identifying new targets and research directions, and exploring appropriate EA stimulation parameters, then provide a detailed methodology to optimize the effects of EA, ultimately reducing the heavy burden of treating AD patients on families and countries. Our review showed that 8 acupoints were used when treating AD animals; Baihui(GV 20) was the most frequently used. Four mechanisms of EA were studied:(1) protection of cerebral neurons from oxidative stress, apoptosis, neuroinflammation, synaptic plasticity and hormone levels;(2) regulation of metabolism, including glucose metabolism and plasma metabolism;(3) regulation of brainderived neurotrophic factor; and(4) regulation of β-amyloid peptide protein deposition.     

帕金森病小鼠模型行为学检测方法的比较研究

目的比较目前常用的5种帕金森病(PD)小鼠模型行为学检测方法在PD研究中的作用。方法用MPTP建立C57BL小鼠PD模型,通过行为学检测(自主活动计数、滚轴实验、游泳实验、爬杆实验、悬挂实验)、免疫组织化学和荧光分光光度法,对比5种行为学检测方法的平均数与变异系数,观察MPTP对PD小鼠模型的行为学、黑质多巴胺(DA)神经元和纹状体酪氨酸羟化酶免疫反应阳性(TH-ir)神经纤维以及纹状体DA水平的影响。结果给与MPTP后,小鼠行为学计数降低,爬杆实验未能得到检测结果,悬挂实验变异系数很高,结果有明显的偶然性,滚轴实验结果变异系数中等,平均数呈现一定的上升趋势,自主活动计数中移动与站立和游泳实验的平均数则呈现明显的下降趋势,变异系数很低,而黑质DA神经元数目减少约58%,纹状体TH-ir神经纤维密度减低,纹状体DA水平明显降低约88%,两组相比差异有显著性(P<0.01)。结论MPTP所致的C57BL小鼠的神经病理、生化改变与PD患者近似,自主活动计数和游泳实验优于其他行为学检测方法。     

不同手术方式治疗创伤性踝关节炎临床疗效对比

目的 分析比较3种不同手术方式治疗创伤性踝关节炎的临床疗效,旨在为临床治疗提供理论依据。方法 选取本院2011年1月～2013年4月收治的90例创伤性踝关节炎患者,按照不同治疗方式将患者分为3组,每组30例,分别采用人工全踝关节置换术（踝关节置换组）和踝关节融合外架固定术（踝关节融合外架固定组）、踝关节融合内固定术（踝关节融合内固定组）。踝关节置换组患者平均随访时间为（34.56±3.42）个月,踝关节融合外架固定组患者平均随访时间为（33.14±3.26）个月,踝关节融合内固定组患者平均随访时间为（36.78±4.57）个月。观察比较3组患者术前、术后AOFAS踝 后足评分、术后生活质量改善情况以及早期临床疗效。结果 3组患者在年龄、性别、随访时间、体重指数（BMI）、术前活动度等临床资料比较无差异（P>0.05）,但踝关节置换组术后踝关节活动度较术前明显改善（P<0.05）;术前3组患者AOFAS踝后足评分比较无差异（P>0.05）,术后3组患者AOFAS踝 后足评分均有升高,但踝关节置换组AOFAS踝 后足评分明显高于踝关节融合外架固定组及踝关节融合内固定组（均P<0.05）,而踝关节融合外架固定组及踝关节融合内固定组间AOFAS踝 后足评分比较无差异（P>0.05）;术前3组患者SF-36评分比较无差异（P>0.05）,术后3组患者SF-36评分均有升高,但踝关节置换组SF-36评分明显高于踝关节融合外架固定组与踝关节融合内固定组（均P<0.05）,而踝关节融合外架固定组与踝关节融合内固定组间SF-36评分比较无差异（P>0.05）;创伤性踝关节炎术后都存在一定的并发症,主要包括骨不连、假体松动、浅深部感染、对位对线不良等,踝关节置换组并发症发生率为20.00%,踝关节融合外架固定组并发症发生率为26.67%,踝关节融合内固定组并发症发生率为26.67%,3组并发症发生率比较无差异（P>0.05）。结论 采用人工全踝关节置换术治疗创伤性踝关节炎比踝关节融合术疗效更好,能更快地改善患者的生活质量,且没有增加患者术后并发症的发生率,可在临床推广应用。     

Frequency-specific Alterations of Large-scale Functional Brain Networks in Patients with Alzheimer's Disease

Background:

Previous studies have indicated that the cognitive deficits in patients with Alzheimer''s disease (AD) may be due to topological deteriorations of the brain network. However, whether the selection of a specific frequency band could impact the topological properties is still not clear. Our hypothesis is that the topological properties of AD patients are also frequency-specific.

Methods:

Resting state functional magnetic resonance imaging data from 10 right-handed moderate AD patients (mean age: 64.3 years; mean mini mental state examination [MMSE]: 18.0) and 10 age and gender-matched healthy controls (mean age: 63.6 years; mean MMSE: 28.2) were enrolled in this study. The global efficiency, the clustering coefficient (CC), the characteristic path length (CpL), and “small-world” property were calculated in a wide range of thresholds and averaged within each group, at three different frequency bands (0.01–0.06 Hz, 0.06–0.11 Hz, and 0.11–0.25 Hz).

Results:

At lower-frequency bands (0.01–0.06 Hz, 0.06–0.11 Hz), the global efficiency, the CC and the “small-world” properties of AD patients decreased compared to controls. While at higher-frequency bands (0.11–0.25 Hz), the CpL was much longer, and the “small-world” property was disrupted in AD, particularly at a higher threshold. The topological properties changed with different frequency bands, suggesting the existence of disrupted global and local functional organization associated with AD.

Conclusions:

This study demonstrates that the topological alterations of large-scale functional brain networks in AD patients are frequency dependent, thus providing fundamental support for optimal frequency selection in future related research.     

Frequency of cognitive impairment and depression in Parkinson's disease: A preliminary case-control study

Background:

This study aimed to determine the frequency of cognitive impairment and depression in our Parkinson''s Disease (PD) and their relationship with disease severity and disability.

Patients and Methods:

A total of 40 PD patients and 40 age-, sex-, and educationally matched controls were studied. The Unified Parkinson Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores and the Hoehn and Yahr (HY) stage were documented. Depression was assessed using the Zung Self-Rating Depression Scale (ZSDS), while cognition was evaluated using a composite score of the mini-mental state examination (MMSE) score and category fluency score.

Results:

A total of 55% (22/40) of PD and 10% (4 of 40) of controls had depression (P<0.001). A total of 60% of PD (24/40) and 5% of controls (2/40) had cognitive impairment (P<0.001). Both NMS coexisted in 16 of 40 PD (40%) compared with none of the controls (P<0.001). UPDRS (motor and ADL) scores and HY stage were significantly worse with impaired ZSDS scores - P 0.001. UPDRS ADL was significantly impaired by the presence of cognitive impairment. Coexisting depression and cognitive impairment were associated with significant worsening of all scores of severity and disability.

Conclusion:

Cognitive impairment and depression accompany our PD and are related to disability and worsening disease severity.     

The role of surgery for pancreatic cancer: a 12-year review of patient outcome

Introduction

Pancreatic cancer has a poor prognosis with <5% alive at 5 years, despite active surgical treatment. The study aim was to review patients undergoing pancreatic resection and assess the effect of clinical and pathological parameters on survival.

Patients and methods

All patients who had undergone radical pancreatic surgery, January 1996 to December 2008, were identified from the unit database. Additional information was retrieved from the patient records. The demographic, clinical, and pathological records were recorded using Microsoft Excel. Survival was assessed using Kaplan-Meier and predictors of survival determined by multinominal logistic regression and log rank test.

Results

126 patients were identified from the database. The majority (106) had a Whipple''s procedure, 14 had a distal pancreatectomy and 6 had local periampullary excision. The average age of the Whipple''s group of patients was 61.7 years (± 11.7) with most procedures performed for malignancy (n=100). Survival was worse with adenocarcinoma compared to all other pathologies (p=0.013), while periampullary tumours had a better prognosis compared to other locations (p=0.019). Survival decreased with poorer differentiation (p=0.001), increasing pT (p<0.001) and pN stage (p<0.001). Survival was worse with perineural (p=0.04) or lymphovascular invasion (p=0.05). A microscopic postive resection margin (R1) was associated with a worse survival (p=0.007). Tumour differentiation (p=0.001) and positive nodal status (p<0.001) were found to be independent predictors of mortality.

Conclusion

Tumour differentiation and nodal status are important predictors of outcome. A positive resection margin is associated with a poorer survival.     

Management of thyroid disorders

Autoimmune thyroid disease is the predominant form of thyroid dysfunction in the developed world. Although its precise cause is currently unclear, principles of management have been established. There is a vigorous debate about the management of the increasingly commonly recognised subclinical forms of thyroid dysfunction despite recent recommendations. Nodular thyroid disease and thyroid carcinoma have received wide attention. The effects of drugs and pregnancy on thyroid function have also been investigated widely. This short review attempts to give an overview and clarify the current management of common thyroid disorders.     

Asthma increase among farmers: a 12-year follow-up

Respiratory disease is a well known health hazard for farmers, but the long-term prognosis is less well known. This is a 12-year follow-up of an investigation of Swedish farmers, most of them dairy farmers. A questionnaire was mailed to all 418 farmers who were alive of the farmers originally participating in 1982. They were invited to an interview, spirometry, and blood sampling. Ninety-one per cent (380) of the farmers, 321 men and 59 women, responded to the questionnaire. The mean age was 56 years for the men and 55 years for the women. Of the group, 10% were smokers, 25% ex-smokers, and 65% had never smoked. The population estimate for asthma in the farmers was 8.9% in 1994 compared to 2% in 1982, and to 5.4%–6.6% in the general population in the region in 1982. Of the asthmatic subjects, one-third had positive RAST tests (radioallergosorbent tests). Almost 90% of the new onset asthma cases since 1982 had non-IgE-mediated asthma. Most of the IgE-mediated asthmatics had had symptoms for many years, while 70% of the non-IgE-mediated asthmatic farmers had no or only wheezing with colds 1982. Two new cases of hypersensitivity pneumonitis were identified, and 7.3% had experienced inhalation fever during the last 12 years. In general, individuals with asthma and chronic bronchitis who had left farming were in better health in 1994 as compared to 1982. In conclusion, farmers have an enhanced risk to develop asthma increasing with age. Asthma in farmers is often non-IgE-mediated.