抑郁症与心脏病

最近,美国哈佛大学医学部和麻省理工大学精神科学者发表文章强调抑郁症在心脏病患者中的发病率较高,约有20%～40%的心脏病人有严重抑郁障碍症状或经历抑郁性的症状。抑郁症状缓慢而持久,     

Current status of pediatric umbilical cord blood transplantation in Korea: a multicenter retrospective analysis of 236 cases

We report the outcome of 236 pediatric umbilical cord blood transplantations (UCBT) performed in Korea. Given that the sources of the grafts were mostly unrelated donors (n = 226; 95.8%), only the results of unrelated UCBT were included for all statistics. The most frequent primary disease was acute leukemia (n = 167). In total, 91.7% of recipients were seropositive for cytomegalovirus (CMV). The median doses of nucleated cells and CD34+ cells were 4.84 × 10(7)/kg and 2.00 × 10(5)/kg, respectively. The median times to neutrophil (>0.5 × 10(9)/L) and platelet recovery (>20 × 10(9)/L) were 18 and 45 days, respectively. Grade 2-4 acute graft-versus-host-disease (GVHD) and chronic GVHD developed in 41.1 and 36.1% of cases, respectively. Forty-five patients developed CMV disease. The 5-year overall and event-free survival were 47.5 and 36.9%, respectively. Multivariate analysis revealed that adverse factors for survival of the whole cohort were total body irradiation-based conditioning (P = 0.007), salvage transplant (P = 0.001), failure to achieve early complete chimerism (P < 0.0005), and CMV disease (P = 0.001). The outcomes of the single- and double-unit UCBT (n = 64) were similar, while double-unit recipients were heavier (P < 0.0005) and older (P < 0.0005). We conclude that double-unit UCBT is a reasonable option for older or heavier children and that the thorough surveillance of CMV infection and the development of an effective CMV therapeutic strategy may be especially important for Korean children, whose CMV seroprevalence exceeds 90%.     

Red blood cell substitutes

Soluble polymerized haemoglobin (polyhaemoglobin) is now in a phase III clinical trials. Patients have received up to 20 units (10 litres) in trauma surgery and other surgery. Polyhaemoglobin can be stored for more than 1 year. Haemoglobin solutions have no blood group antigen and can be used as a 'universal donor' oxygen carrier. They can also be sterilized. With a circulation half-life of 24 hours they are undergoing trials for peri-operative use. For conditions with potential for ischaemia-reperfusion injuries, a new polyhaemoglobin-superoxide dismutase-catalase, which can reduce oxygen radicals, is being developed. Recombinant human haemoglobin has been tested in clinical trials, and a new type of recombinant human haemoglobin that has low affinity for nitric oxide is being developed for clinical trials. To increase the circulation time, artificial red blood cells have been prepared with a bilayer lipid membrane (haemoglobin liposomes) or with a biodegradable polymer membrane-like polylactide (haemoglobin nanocapsules). Synthetic chemicals such as perfluorochemicals are also being developed and tested in clinical trials as red blood cell substitutes.     

Microtubule-associated protein 2, an early blood marker of ischemic brain injury

The aim of this study was to develop a sensitive and rapid blood marker to detect ischemic brain injury, because imaging techniques have a limited capacity to identify lesions during the first crucial hours without massive tissue destruction. Rats were subjected to middle cerebral artery occlusion for various durations (0.5-3 hr), followed by reperfusion. At different time points after ischemia and/or ischemia-reperfusion, the amounts of glial fibrillary acidic protein (GFAP) and microtubule-associated protein 2 (MAP2) in the cerebrospinal fluid (CSF) and serum were analyzed by Western blotting. Brain infarction was observed in an ischemia-duration-dependent manner. GFAP was drastically increased in the CSF 24 and 48 hr after reperfusion, without change in the serum level. Serum levels of MAP2 remarkably increased as early as 0.5 hr of ischemia, much earlier than the observation of minimal tissue injury 3 hr following occlusion. The serum MAP2 level was further increased by a short period (2 hr) of reperfusion, even in 0.5- and 1-hr ischemic rats, despite not observing any typical tissue injuries 24 hr after reperfusion. These results indicate that the MAP2 protein may be able to detect early neuronal injuries, because the level of this protein in the blood spikes before the appearance of visible macrolesions. Therefore, MAP2 could potentially be used as a novel early marker for the detection of a neurotoxic insult.     

A simplified method to determine left atrial volume and transport function using multi-slice computed tomography in patients with atrial fibrillation: comparison with transthoracic echocardiography

Although left atrial volumes (LAVs) and transport function can be accurately measured by multi-slice computed tomography (MSCT) during sinus rhythm, limited data are available for in patients with atrial fibrillation (AF). The aims of our study were to compare LAVs and function assessed by MSCT and transthoracic echocardiography (TTE) during AF, and to validate a simplified method to determine LAVs and functions using MSCT. A total of 150 consecutive AF patients who were scheduled to undergo catheter ablation were enrolled in this study. All subjects underwent MSCT and TTE on the same day. LAVs were measured by MSCT at every 10% of the R-R interval (10-phase analysis). LA transport function was assessed by measuring changes in LAVs. LAVs and functions were also assessed by TTE using a modified Simpson's method and an area-length method. Fifty patients were in sinus rhythm (SR) and 100 were in AF during their examinations. Although TTE underestimated the maximal LAV (LAV(max), by 38.3%) and overestimated the total LA emptying fraction (LAEF(total), by 61.1%) compared with MSCT, there were excellent correlations between TTE and MSCT. LAV(max) and the minimal LAV (LAV(min)) based on MSCT were determined at relatively constant cardiac phases during AF as well as SR (LAV(max); 40%, LAV(min); 100% of R-R interval, fixed-phase analysis). LAVs and LAEF(total) assessed by 10-phase analysis showed good correlations with those assessed by fixed-phase analysis (P < 0.001). LAVs and function assessed by MSCT correlated well with LAVs and functions assessed by TTE, irrespective of the underlying rhythm. Our results indicate that in the context of MSCT, fixed-phase analysis is a simple and reliable method to determine LAVs and function in patients with AF.     

The clinical characteristics of motor function in chronic hemiparetic stroke patients with complete corticospinal tract injury

Clarification of the clinical characteristics of motor function in stroke patients with complete corticospinal tract (CST) injury would be of importance in stroke rehabilitation. However, this topic has not been clearly elucidated. We conducted an investigation of the clinical characteristics of motor function in chronic hemiparetic stroke patients with complete CST injury, as confirmed by transcranial magnetic stimulation and diffusion tensor imaging. Forty-one consecutive chronic hemiparetic stroke patients who showed an absence of motor evoked potential in muscles of the upper and lower extremities upon transcranial magnetic stimulation and in whom the integrity of the CST discontinued around stroke lesion on diffusion tensor imaging tractography were recruited. Mean Medical Research Council scores for distal musculature were lower than those for proximal musculature (P< 0.001). Mean Medical Research Council scores for upper extremity muscles were lower than those for lower extremity muscles (P< 0.001). The mean Motricity Index score for muscles of the upper extremities was lower than that for muscles of the lower extremities (P< 0.001). None of the patients had a functional hand; in contrast, 56% of patients were able to walk independently. We found that motor weaknesses of distal joint musculature and upper extremities were more severe than those of proximal joint musculature and lower extremities following complete injury of the CST in stroke, respectively. As a result, despite the absence of a functional hand in all patients, more than half were able to walk independently.     

The Economic Effect of Early Management in Patients with Early Chronic Obstructive Pulmonary Disease: Results from a Population-Based Nationwide Survey

Lung - The economic effect of regular follow-up and early management in patients with early chronic obstructive pulmonary disease (COPD) has not yet been clarified. Therefore, this study aimed to...