Coronary sinus blood sampling: an insight into local cardiac pathophysiology and treatment?

Atherosclerosis remains the underlying cause of cardiovascular disease and is a dynamic process involving inflammation, haemostasis, endothelial dysfunction, and angiogenesis. Studies of circulating factors from peripheral blood can provide an insight into this pathophysiology but may remain indicative of a more generalized, systemic process. More localized interaction(s) within the heart may be better studied from coronary blood samples. Indeed, an increasing number of prospective studies show good correlation between indices of these processes and clinical outcomes. As local sampling offers a unique way of assessing the local cardiac milieu, this may prove useful in the monitoring of both local/systemic drug therapies and interventional technologies.     

Bilateral subthalamic nucleus stimulation and quality of life in advanced Parkinson's disease.

We examined the impact of the subthalamic nuclei (STN) deep brain stimulation (DBS) on the health-related quality of life (QoL) of patients with advanced Parkinson's disease (PD). Seventeen consecutive patients with refractory motor fluctuations and dyskinesia were included in the study (mean age, 60.9 +/- 7.7 years [range, 43-74 years]; disease duration, 16.4 +/- 8.5 years [range, 7-38 years]; mean off-medication Hoehn and Yahr stage, 4.23 +/- 0.66 [range, 2.5-5]). Each patient's assessment was carried out using common rating scales, following the Core Assessment Program for Intracerebral Transplantation (CAPIT) protocol. Dyskinesia and emotional state were evaluated through the Abnormal Involuntary Movement Scale (AIMS) and the Hospital Anxiety and Depression Scale (HAD). QoL was assessed by means of the Parkinson's Disease Questionnaire Spanish version (PDQ-39). Significant benefit was obtained in the motor manifestations and complications of disease, as well as in the functional state and mood (P < 0.001). Some QoL dimensions (mobility and activities of daily living) and the PDQ-39 Summary Index (PDQ-39SI) showed a significant improvement (P < 0.001). Benefit was modest (P < 0.05) for three other domains (emotional well-being, stigma, bodily discomfort) and nil for the rest. There was no correlation between the change obtained in the QoL (PDQ-39SI) and in the other variables. As measured by the PDQ-39, STN-DBS significantly improves important aspects of QoL in patients with advanced PD.     

The validation of a Japanese version of the Everyday Memory Checklist]

We developed a Japanese version of the Everyday Memory Checklist(EMC), which was originally made by Wilson et al. to assess everyday memory problems, and examined its reliability and validity in assessing brain-damaged patients with memory deficits. SUBJECTS AND METHODS: The subjects consisted of 393 brain-damaged patients with memory deficits aged between 17 and 90 years with the mean MMSE of 24.6, and 132 control subjects aged between 19 and 86 years with the mean MMSE of 28.5. Patients' everyday memory problems were both self-evaluated and evaluated by their caregivers, while those of control subjects were only self-evaluated with the EMC. RESULTS: The test-retest reliability of the EMC evaluated in 149 randomly selected patients was acceptably high with intraclass correlation coefficient (0.950 for caregiver-evaluated scores and 0.759 for self-evaluated scores). The standard memory test scores were significantly correlated with the EMC scores of the patients evaluated by the caregivers; among them the scores of the Rivermead Behavioural Memory Test were most highly correlated with the EMC scores. On the other hand, the scores of the non-memory cognitive test scores were not significantly correlated with the EMC scores. The self-evaluated EMC scores of the patients were significantly lower than those of the patients evaluated by the caregivers, and were not correlated with memory test scores or with non-memory cognitive test scores. As the EMC scores of control subjects over 60 years were significantly higher than the scores of the subjects under 59 years, we compared the EMC scores between the patients and the control subjects after we divided each subject into two groups depending on age. The EMC scores of the patients evaluated by the caregivers were significantly higher than the score of the control subjects in groups of both over 60 years and under 59 years. However, the self-evaluated EMC scores of the patient were not significantly higher than the EMC scores of the control subjects. In the analysis of the diagnostic accuracy, the EMC scores of the patients evaluated by the caregivers correctly classified 40.9% of patients and 92.9% of normal subjects by setting the cut-off scores of 14/15 in subjects under 59 years, and classified 50.2% of patients and 85.5% of normal subjects by setting the cut-off scores of 16/17 in subjects over 60 years. CONCLUSION: When caregivers evaluated the amnesic patients, the Japanese version of the EMC is reliable and valid in assessing everyday memory problems.     

脑神经胶质瘤病的诊断和治疗

目的 探讨脑神经胶质瘤病的临床特征及其诊断和治疗。方法 回顾性分析9例经开颅手术或定向活检证实为脑神经胶质瘤病的临床表现。影像学资料及治疗效果。结果 9例均有颅高压表现。CT扫描共发现23个病灶。其中病灶累及3个脑叶5例。累及2个脑叶4例，CT平扫病灶呈高密度5个。等密度5例。低密度13例。大多数病灶强化不明显，瘤周轻中席子工水肿，4例行MRI检查发现胼胝体肥大2例。9例均获得半年以上随访。结论 CT扫描易误诊为转移瘤，MRI扫描对脑神经胶质瘤病的诊断有一定的价值。确诊依赖于病理检查。手术切除程度是决定预后的重要因素。术后分割放疗是控制肿瘤生长及延迟复发的重要辅助治疗手段。     

A case of neonatal haemochromatosis

We describe a case of neonatal haemochromatosis, pointing out the difficulties in diagnosing this fatal disease, which here involved the early occurrence of hepatic carcinoma.     

Expression of the novel T cell activation molecule hpH4 in HIV-infected patients: correlation with disease status

We have described hpH4, a surface glycoprotein selectively expressed by activated T cells and mature thymocytes and displaying weak lateral association with CD4. The hpH4 expression pattern and biochemical features, together with analysis of its tryptic digest by peptide mass searching using MALDI-MS, suggested that it is a novel molecule. The aim of this work was to evaluate the peripheral blood T cell expression of hpH4 in HIV-infected patients and the interplay between HIV gp120 and hpH4, since both molecules interact with CD4. hpH4 expression during HIV-1 infection was evaluated by assessing 55 patients at various disease stages and following up 3 patients with primary infection and 3 patients with AIDS. hpH4 expression displayed a peak in the early phase of primary infection, dropped to control levels in the asymptomatic phase, and was newly expressed, at low levels, as AIDS developed. The expression kinetics were different than those shown by HLA-DR, CD25, and CD38. The most striking findings were the transient hpH4 expression peak displayed in the earliest stage, which was unique for hpH4. Incubation of T cells from normal donors with HIV gp120 induced transient hpH4 expression in resting CD4+ T cells and potentiated the hpH4 lateral association with CD4 in activated T cells. Moreover, hpH4 triggering inhibited gp120-induced death of CD4+ cells. Therefore, H4 expression may be a response to avoid apoptosis induced by HIV products.