Developing a Brief Neuropsychological Battery for Early Diagnosis of Cognitive Impairment

ObjectivesEarly diagnosis of cognitive impairment is increasingly emphasized in the literature to facilitate timely preventive interventions. Although bedside cognitive tests such as the Montreal Cognitive Assessment (MoCA) are widely used for such early diagnostic purposes, they may not have comparable performance to a full neuropsychological battery (FNB) in diagnosing early cognitive impairment. This study investigated whether a small subset of neuropsychological tests can be added on to MoCA to match its performance to that of the FNB in discriminating mild cognitive impairment and dementia (MCI/dementia) from normal cognition.DesignCross-sectional diagnostic study.SettingAlzheimer's Disease Centers across the United States.ParticipantsOlder participants (≥50 years) who completed MoCA and the FNB (N = 9187).MeasuresThe study sample was split into two: the derivation sample (n = 1837) was used to develop a brief neuropsychological battery that best discriminated MCI/dementia (using the best-subset approach with 10-fold cross-validation); while the validation sample (n = 7350) verified its actual performance in discriminating MCI/dementia.ResultsA 3-item neuropsychological battery was identified, comprising MoCA, Benson Complex Figure Recall, and Craft Story 21 Delayed Recall. It had excellent performance in discriminating MCI/dementia from normal cognition (area under the receiver operating characteristic curve [AUROC] 90.0%, 95% confidence interval [CI] 89.2%-90.7%), which was comparable to that of the FNB (AUROC 88.4%, 95% CI 87.6%-89.2%). By contrast, MoCA alone had significantly worse AUROC (86.9%, 95% CI 86.0%-87.7%) than that of the FNB.Conclusions/ImplicationsUsing rigorous methods, this study developed a brief neuropsychological battery that maintained the brevity of a bedside cognitive test, while rivaling the diagnostic performance of an FNB in early cognitive impairment. This brief battery offers a viable alternative when the FNB is needed but cannot be feasibly administered in nonspecialty clinics. It can have a wider health systems effect of improving patients’ access to accurate diagnosis in early cognitive impairment and facilitating timely interventions to delay the progression of cognitive impairment.     

铜绿假单胞菌噬菌体PaP3生物学特性的研究

目的测定铜绿假单胞菌噬菌体PaP3的最佳感染复数、一步生长曲线和吸附K值及交叉吸附K值等基本生物学特性。方法按照感染复数（MOI）分别为0．0001、0．001、0．01、0．1、1和10加入噬菌体纯培养液和宿主菌，充分裂解细菌后，测定噬菌体滴度；以MOI=10的比例加入噬菌体及宿主菌，进行一步生长实验；纯化PaP3颗粒，免疫家兔，获得抗血清，通过中和反应实验测定PaP3和其抗血清之间的吸附反应常数K值。同时，利用抗血清交叉中和试验确定本室分离的三株噬菌体之间的血清学关系。结果当MOI=0．001时PaP3感染其宿主菌产生的子代噬菌体滴度最高；根据一步生长实验结果绘制一步生长曲线；通过血清交叉中和反应得出不同的吸附常数。结论PaP3最佳感染复数为0．001，感染宿主菌的潜伏期是20min，爆发期是60min，平均爆发量约为31，其抗血清反应的吸附常数K值为262。     

脊椎转移瘤增强减影MR成像

目的评估增强减影在脊椎转移瘤MR I中的应用价值。方法50例脊椎转移瘤病人进行MR I增强扫描,对比剂采用Gd-DTPA(0.1 mmol/kg),然后用T1W I增强后的图像与增强前的图像进行减影。通过对比噪声比(CNR)、信噪比(SNR)以及肿瘤边界清晰程度的比较,对MR I减影与否进行评估。结果MR I对比增强减影图像比传统的T1W I增强图像显示更清晰、更直观。所有脊椎转移瘤图像MR I减影的CNR和SNR比常规T1W I增强图像的CNR和SNR高。MR I减影CNR为155.05±24.73(x±SD),常规T1W I增强图像的CNR为11.11±14.26(t=35.65,Ρ<0.001)。MR I减影SNR为192.82±32.89(x±SD),常规T1W I增强图像的SNR为46.03±28.22(t=23.95,Ρ<0.001))。MR I对比增强减影图像比传统的T1W I增强图像能更好地显示脊椎转移瘤的边界和侵犯情况(2χ=29.34,Ρ<0.005)。结论MR I增强减影为探查和评估脊椎转移瘤提供了一个新的诊断方法。     

白黎芦醇对GH3细胞增殖和PRL合成的影响

目的 探讨白黎芦醇对垂体腺瘤GH3细胞增殖和泌乳素合成的影响，及其对雌激素的拮抗作用。方法 在无血清无酚红的培养条件下，白黎芦醇单独或与雌二醇联合作用于GH3细胞，用MTT法测定细胞增殖，用免疫荧光法、RT-PCR和Western印迹法测定泌乳素的表达情况。结果 白黎芦醇对GH3细胞增殖具有刺激和抑制双相作用，呈时间一剂量依赖性。并且白黎芦醇使GH3细胞中PRL阳性细胞比例下降。同时，白黎芦醇抑制泌乳素的合成。白黎芦醇对雌二醇诱发的细胞增殖和泌乳素合成均有拮抗作用．但对泌乳素合成的拮抗作用较强，而雌二醇刺激细胞增殖作用较其诱发泌乳素合成作用强。结论 白黎芦醇对GH3细胞增殖和泌乳素合成均有抑制作用，从两方面发挥着抗肿瘤作用。     

神经电生理对腓总神经卡压的诊断价值

目的 观察神经电生理检测对腓总神经卡压的诊断价值。方法 对腓总神经卡压的临床特征及病因进行分析，并作神经传导速度和肌电图检测和分析。结果 21条患病神经中1条神经波形消失。其余有不同程度的传导速度减慢，尤其是跨腓骨小头段，波幅降低，传导时间延长，42块腓总神经支配的肌肉中有30块出现失神经电位。结论 神经电生理检查在腓总神经卡压的诊断中有重要意义。     

Outcomes of Donor Evaluations for Adult-to-Adult Right Hepatic Lobe Living Donor Liver Transplantation

The purpose of this study is to determine the role of liver biopsy and outcome of patients undergoing donor evaluation for adult-to-adult right hepatic lobe living donor liver transplantation (LDLT). Records of patients presenting for a comprehensive donor evaluation between 1997 and February 2005 were reviewed. Liver biopsy was performed only in patients with risk factors for abnormal histology. Two hundred and sixty patients underwent a comprehensive donor evaluation and 116 of 260 (45%) were suitable for donation, 14 of 260 (5.4%) did not complete evaluation and 130 of 260 (50%) were rejected. Four patients underwent unsuccessful hepatectomy surgery due to discovery of intraoperative abnormalities. Between 1997 and 2001, the acceptance rate of donor candidates (63%) was higher than 2002-2005 (36%), p < 0.0001. Sixty-six of the 150 eligible patients (44%) fulfilled criteria for liver biopsy and 28 of 66 (42%) had an abnormal finding. Less than half of the patients undergoing donor evaluation were suitable donors and the donor acceptance rate has declined over time. A large proportion of the patients undergoing liver biopsy have abnormal findings. Our evaluation process failed to identify 4 of 103 who had aborted donor surgeries.     

妇科门诊子宫颈病变常识问卷调查

目的了解我院门诊就诊者对子宫颈病变相关知识的认识。方法自制问卷调查表，采用无记名，当面问卷调查方式。结果从调查100例就诊者中，未做过健康体检、妇科盆腔检查和宫颈刮片检查分别为34例、24例和52例。对宫颈癌的认识不知道者53例。结论建议相关部门加强对妇女的健康教育，提高其健康意识，强化临床医生的防癌意识和对子宫病变的规范化诊治。     

下颈椎可屈性与寰枢关节Magerl固定术的可行性分析

目的:探讨下颈椎的屈曲程度与后路经寰枢关节螺钉固定术的可能性。方法:回顾已施行经寰枢关节螺钉固定术病例的术前颈椎过屈位X线像,测量C2～C7间的角度,复习手术经过,分析可完成螺钉固定的颈椎曲度及其它相关因素。结果:在已完成后路经寰枢关节螺钉固定术的75例患者中有58例屈颈侧位X线像显示下颈椎呈后凸状态,后凸角平均为17.25°;另17例屈颈侧位片见下颈椎呈前凸状态,但这些病例都是体形瘦长者。结论:后路经寰枢关节螺钉固定术仅适合于下颈椎可以很好屈曲及体形瘦长的病例。     

Pick’s disease with Pick bodies combined with progressive supranuclear palsy without tuft‐shaped astrocytes: A clinical,neuroradiologic and pathological study of an autopsied case

We report clinical, neuroradiologic features, and neuropathologic findings of a 76‐year‐old man with coexistent Pick’s disease and progressive supranuclear palsy. The patient presented with loss of recent memory, abnormal behavior and change in personality at the age of 60. The symptoms were progressive. Three years later, repetitive or compulsive behavior became prominent. About 9 years after onset, he had difficulty moving and became bed‐ridden because of a fracture of his left leg. His condition gradually deteriorated and he developed mutism and became vegetative. The patient died from pneumonia 16 years after the onset of symptoms. Serial MRI scans showed progressive cortex atrophy, especially in the bilateral frontal and temporal lobes. Macroscopic inspection showed severe atrophy of the whole brain, including cerebrum, brainstem and cerebellum. Microscopic observations showed extensive superficial spongiosis and severe neuronal loss with gliosis in the second and third cortical layers in the frontal, temporal and parietal cortex. There were Pick cells and argyrophilic Pick bodies, which were tau‐ and ubiquitin‐positive in neurons of layers II–III of the above‐mentioned cortex. Numerous argyrophilic Pick bodies were observed in the hippocampus, especially in the dentate fascia. In addition, moderate to severe loss of neurons was found with gliosis and a lot of Gallyas/tau‐positive globus neurofibrillary tangles in the caudate nucleus, globus pallidus, thalamus, substantia nigra, locus coeruleus and dentate nucleus. Numerous thorned‐astrocytes and coiled bodies but no‐tuft shaped astrocytes were noted in the basal ganglion, brainstem and cerebellar white matter. In conclusion, these histopathological features were compatible with classical Pick’s disease and coexistence with progressive supranuclear palsy without tuft‐shaped astrocytes.     

噬菌体基因组PaP1的鸟枪法测序及其生物信息学分析

目的对分离的铜绿假单胞菌噬菌体PaP1进行全基因组测序，并进行初步的生物信息学分析，为噬菌体的改造及其治疗奠定基础。方法采用鸟枪法随机测序和重叠群组装的策略对PaP1进行基因组测序，并通过EditSeq、开放读码框架（ORF）finder、GeneMark^TM、BPROM、FindTerm、Palindromes、Equicktandem及FAStRNA等软件对所获得的基因组序列的一般特征、蛋白质同源性序列及tRNA基因等进行分析和预测。结果PaP1基因组约为90000bp，其中最大重叠群为28249bp。在已获得序列中预测出120个ORFs、41个推定基因及9个簇集在5’末端的tRNA基因。在41个推定基因中，预测出编码DNA末端酶大亚单位、DNA解旋酶B亚单位、肽聚糖结合蛋白及3个尾丝蛋白等6个基因的功能。结论鸟枪法只能测出噬菌体基因组PaP1的部分序列，重复序列的存在是该基因组测序困难的原因。