ACE及AT1受体在肌营养不良中表达的临床病理意义

目的揭示肾素-血管紧张素系统（RAS）在肌营养不良（MD）中的作用。方法应用免疫组织化学法、双免疫荧光标记和Western blot分析检测Duchenne型肌营养不良（DMD）、Becker型肌营养不良（BMD）和先天性肌营养不良（CMD）患者肌肉活检标本中血管紧张素转移酶（ACE）及血管紧张素Ⅱ（AngⅡ）1型（AT1）受体的表达及细胞定位。结果免疫组织化学和双免疫荧光标记显示正常肌肉的血管内皮细胞为ACE阳性，而AT1受体只在正常肌肉的血管平滑肌细胞中表达。免疫组织化学法和Western blot分析均显示在MD的萎缩肌肉中ACE和AT1受体的免疫反应明显增强，ACE和AT1受体均在再生纤维的膜、细胞浆和细胞核，成纤维细胞，巨噬细胞和巨噬细胞浸润的坏死纤维中强烈表达。双免疫荧光标记显示DMD和CMD肌肉的肌内膜和肌束膜中大多数激活的成纤维细胞表达ACE和AT1受体，特别是AT1更强烈。AT1受体的免疫反应基本与ACE的反应相平行。结论局部ACE和AT1受体表达增加，表明肌肉组织中RAS在MD时被激活，可能在MD的发病巾起作用。     

晚发型糖原累积病II型的临床和病理研究

目的：总结晚发型糖原累积病II型（CSDII型）的临床及病理学特点。方法：回顾性分析11例GSDII型患者的临床和病理资料,并对部分患者进行随访。结果：临床表现为对称性四肢肌无力,以近端受累为主,可伴有呼吸肌无力,肌酸激酶（cK）可有不同程度升高,肌电图检查均呈肌源性损害肌电表现,可伴肌强直电位。外周血α-1,4-葡萄糖苷酶活性明显减低,肌肉活组织检查均以肌纤维空泡样变为主要病理特征,过碘酸希夫反应可见空泡内大量糖原沉积,酸性磷酸酶染色阳性。结论：晚发型GSDII型多表现为慢性肌病,易累及四肢肌和呼吸肌,血清CK轻度至中度升高,肌肉病理见明显空泡样变。α-葡萄糖苷酶活性明显减低,有助于确诊。     

2家系面肩肱型肌营养不良临床分析

目的探讨面肩肱型肌营养不良的临床特点。方法对2个家系患者的临床资料进行分析。结果患者起病多在青春期，男性多于女性，病情呈进行性发展，临床主要表现为肌萎缩和肌无力主要累及面肌、肩带肌和上臂肌群，常见翼状肩；肌电图显示肌源性损害，肌肉活检表现肌病特征。结论该病临床异质性很高，无特殊有效治疗，预后相对良好。     

重症肌无力合并肌电图肌源性损害53例临床和电生理特点

目的研究重症肌无力（myasthenia gravis，MG）合并肌电图肌源性损害患者的临床和电生理特点。方法收集1998-2006年中国医学科学院北京协和医院神经科肌电图室收治的MG合并肌源性损害患者共53例，对其临床和电生理特点进行回顾性分析。结果在本组患者中，早发型患者占69．81％（37／53），早发型中女性患者明显多于男性（分别为26例和11例,X^2=5．281，P〈0．05）。延髓部肌肉受累者多见，占50．94％（27／53）。仅1例患者具有肌肉萎缩的临床表现。合并其他免疫相关疾病患者占15．09％（8／53）。2例患者（3．77％）重复频率电刺激正常，但肌电图示肌源性损害。15例患者进行肌酶谱检查，其中1例轻度异常。结论对于MG合并肌源性损害的患者，要结合临床特征、电生理检查等进行综合分析来区别“真性”和“假性”的肌源性损害。行甲状腺功能、自身抗体等检查有助于发现潜在的自身免疫系统疾病。     

98例神经肌肉病的临床、肌电图与病理研究

目的 探讨肌电图（EMG），肌活检对神经肌肉病的诊断价值。比较EMG，肌活检及初始临床诊断3者之间的关系。方法 将98例神经肌肉病分成肌病。重症肌无力和运动神经元病3组进行研究。结果 肌病组（80例），68.8%(55/80)肌活检，75%（60/80）EMG呈肌源性损害；重症肌无力组（10例）；针极EMG（不包括重视频率电刺激）及肌活检均未显示特异性改变；运动神经元病组（8例），75?/8）肌活检，100%（8/8）EMG呈神经源性损害。结论 肌活检对肌病明确诊断可提供直接信息。对运动神经元病只能做出神经源性损害结果。缺乏特异性。EMG对神经肌肉病只能做出分类诊断；单纯凭借初始临床资料易导致该类疾病误诊。     

脂质沉积性肌病诊断及误诊分析

目的分析脂质沉积性肌病（LSM）的临床及病理特点,探讨脂质沉积性肌病被误诊的原因。方法分析8例确诊为脂质沉积性肌病患者的临床特点、实验室检查、神经电生理及病理学资料。结果LSM的临床特点是四肢近端肌无力和运动不耐受;肌酶谱轻中度甚至重度升高;肌电图表现肌源性损害、神经源性损害或混合性损害;肌肉病理学检查显示肌纤维中大小不等的空泡形成;7例0R0染色显示Ⅰ型肌纤维中大量脂质颗粒沉积,1例显示脂肪成分正常者电镜检查可见肌纤维内大量脂滴沉积,呈串珠状排列。2例进行神经活检,1例正常,1例光镜下部分髓鞘变薄,崩解脱失。电镜下髓鞘板层分离,雪旺氏细胞内出现脂滴沉积。确诊的LSM曾被误诊为多发性肌炎、肢带型肌营养不良、脊肌萎缩症、胶原血管病、慢性吉兰-巴雷综合征、病毒性心肌炎。结论LSM很易被误诊为其他肌病或神经源性肌病,肌肉活检及组化OR0染色可能染色不成功造成阴性结果,电镜检查是诊断LSM的主要依据。     

脂质沉积性肌病临床及病理特点

目的探讨脂质沉积性肌病（ＬＳＭ）的临床及病理特点。方法报告４例ＬＳＭ的临床特点，并对治疗前后的肌肉活检进行病理研究。结果４例患者均表现为进行性四肢无力，以近端肌为重，其中１例以活动后肌无力明显加重为主。血清肌酶谱增高或正常。肌电图以肌源性损害为主。肌肉病理检查（光、电镜下）示肌纤维中大量脂质颗粒沉积，Ⅰ型肌纤维受累重。经低长链脂肪酸饮食、激素，核黄素治疗，症状基本恢复，复查肌肉病理示肌纤维中脂质颗粒基本消失。结论ＬＳＭ是一种病因尚未完全阐明的疾病，临床以不能耐受运动和近端肌无力为主要表现，肌肉病理检查有助于确诊，ＬＳＭ是可以治疗的。     

成人型近端脊髓性肌萎缩症的临床和肌肉病理学研究

目的 总结成人型近端脊髓性肌萎缩症(ASMA)临床和肌肉病理学特征，以提高对ASMA的认识。方法 对27例完成肌肉活检的ASMA患者进行临床及肌肉病理学分析。结果 该病多于45岁左右发病，起病及进展均缓慢，主要表现为近端肌肉无力、肌肉萎缩、肌束震颤，锥体束和周围神经一般不受累。4例患者肌酶增高。所有患者肌电图检查示神经源性损害，其中2例伴肌源性改变。肌肉活检光镜下见神经源性肌萎缩，其中3例伴肌源性损害。电镜下见肌原纤维数量减少、排列紊乱、部分断裂，Z线变粗或呈波浪样以及肌核聚集。结论 结合临床表现进行肌肉活检对ASMA诊断及鉴别诊断具有重要价值。     

杆状体肌病合并先天性单一Ⅰ型肌纤维肌病临床及病理报告

目的探讨杆状体肌病及单一Ⅰ型肌纤维肌病的临床及病理特点。方法杆状体肌病合并单一Ⅰ型肌纤维肌病患者行组织化学染色病理分析。结果肌肉活检modified Gomori trichrome（MGT）染色肌浆内、肌膜下紫色杆状体聚集ATPase染色（酸性、碱性）肌纤维类型几乎全部为Ⅰ型肌纤维，散在单个Ⅱ型肌纤维。结论肌活检发现特异性杆状体、单一型肌纤维分布是确诊此类疾病的唯一可靠方法。     

类固醇肌病的临床和病理特点分析（附10例报道）

目的：探讨类固醇肌病的临床和病理特点。方法：收集2007至2011年收治的10例有使用糖皮质激素史,并经肌肉活检病理证实的类固醇肌病患者的临床资料,分析并总结其临床和病理特点。结果：10例类固醇肌病患者中女性6例、男性4例,年龄14~79（51.1±18.5）岁。使用激素后至起病时间为7 d至14个月。所有病例均表现为四肢近端无力,股四头肌均呈不同程度萎缩,7例以双下肢近端受累为主,3例同时有上臂肌群萎缩;血清肌酸激酶（CK）和CK-mb均正常,9例乳酸脱氢酶（LDH）值高于正常上限;肌电图示轻度肌源性损害;肌肉活检均可见肌纤维大小不一;酶学染色提示：Ⅱ型纤维选择性萎缩。结论：类固醇肌病好发于中老年人群,多在使用糖皮质激素数周至数月后发生,肌无力和肌萎缩以下肢近端为主,血清CK基本正常,LDH轻度增高,肌肉病理示选择性Ⅱ型纤维萎缩为其病理特点。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.