Postural orthostatic tachycardia syndrome associated with multiple sclerosis

BackgroundThe aim of this study was to determine if there is a difference in the frequency of postural orthostatic tachycardia syndrome (POTS) in patients with multiple sclerosis (MS) compared to patients with symptoms of orthostatic intolerance and with no evidence of MS or other neurological illness.MethodsWe analyzed data gathered from 293 patients who underwent the head-up tilt table test protocol. Group 1 included prospectively analyzed 112 with MS and group 2 included retrospectively analyzed 181 patients who were evaluated because of symptoms of orthostatic intolerance, and with no evidence of MS or other neurological illness. If POTS was identified the head-up tilt table test was repeated and supine as well as standing serum epinephrine and norepinephrine were determined.ResultsPOTS was identified in 39 patients: 21 (19%) in the MS group comparing to 18 (10%) in the non MS group (p = 0.035). There was no difference between groups in the occurrence of POTS associated syncope (p = 0.52). There was no difference between groups in the epinephrine or norepinephrine in supine and standing positions. While both standing epinephrine and norepinephrine levels were significantly higher compared to levels in the supine position in the non MS group, only standing norepinephrine levels were significantly higher in the MS group.ConclusionsThe results of this study suggest that POTS is associated with MS.     

3种含酚羟基化合物对蘑菇酪氨酸酶活性影响及动力学研究

选取3种具有酚羟基的芳香类化合物,测定其对酪氨酸酶的活性影响。结果表明,1,5-二羟基萘在120~600 μmol·L-1范围内对酪氨酸酶的激活活性＞450%,最高为537%;2,2′-联苯酚的激活活性最大为284%;2,2′-联吡啶-3,3′二醇无激活活性。动力学研究表明,1,5-二羟基萘表现为非竞争性激活;2,2′-联苯酚为混合性激活作用,在酶促反应体系中,既影响底物与酶的结合,又改变酶的空间构型,综合提高反应速度。     

Histone deacetylases (HDACs) as therapeutic target for depressive disorders

Major depressive disorder (MDD) represents approximately 40% of the disability caused by mental illnesses globally. The poorly understood pathophysiology and limited efficiency of pharmacological treatment (based primarily on the principles of the monoaminergic hypothesis) make depression a serious medical, public and socio-economical problem. An increasing number of studies suggest that epigenetic modifications (alterations in gene expression that are not due to changes in DNA sequence) in certain brain regions and neural circuits represent a key mechanism through which environmental factors interact with individual's genetic constitution to affect risk of mental disorders. Accordingly, chromatin-based epigenetic regulation seems to be a promising direction for the development of new, more effective antidepressant drugs. Recently, several inhibitors of histone deacetylases (HDAC) have been extensively studied in the context of antidepressant action. So far, none of them has been used to treat depression in humans due to the low selectivity for specific HDAC isoforms, and consequently, a risk of serious adverse events. In this review, we focus on the HDAC inhibitors (HDACi) with the greatest antidepressant efficacy and their activity in the preclinical studies. Moreover, we discuss their potential therapeutic usefulness in depression and the main limitations.     

“3S2E”护理管理及服务模式在脑卒中吞咽功能障碍患者中的应用

目的探讨"3S2E"护理管理模式在脑卒中吞咽功能障碍患者中的应用效果。方法选择2017年1—12月江苏省徐州市中心医院康复科收治的脑卒中伴吞咽功能障碍患者93例,将2017年1—6月的患者设为对照组(n=42),2017年7—12月的患者设为观察组(n=51),对照组患者住院期间、出院时给予常规护理措施及出院指导;观察组患者在对照组基础上实施"3S2E"护理管理模式,主要包括提高护理人员的业务技能、强化护理人员的服务意识、保障护理安全、对患者进行吞咽功能评估及健康教育。结果治疗4周后,观察组患者的吞咽功能障碍风险程度、吞咽功能障碍评分低于于对照组(P均0.05),观察组患者的误吸人次数和吸入性肺炎人次数均少于对照组(P均0.05),观察组患者血红蛋白、血清白蛋白水平高于对照组(P均0.05),且两组患者在护理满意度等级分布上存在统计学差异(P0.05)。结论 "3S2E"护理管理模式的实施,不仅改善了脑卒中吞咽障碍患者的吞咽功能,降低了患者不良事件的发生率,也提升了患者的护理满意度,保障了护理安全。     

实时三维超声及斑点追踪技术评价左室射血分数保留的行血液透析终末期慢性肾疾病患者右心室收缩功能

目的 采用实时三维超声及三维斑点追踪技术（3D-STI）对左室射血分数保留的终末期慢性肾疾病（ESRD）患者的右心室收缩功能进行评价。方法 纳入规律血液透析的左室射血分数保留的ESRD患者43例,诊断标准GFR＜15mL/(min·1.73m2),根据是否合并肺动脉高压分为ESRD组(n=23)、ESRD合并肺动脉高压组(n=20),对照组选择25例健康志愿者。测量各心腔大小、LVEF及右室做功指数（RIMP）;应用实时三维超声测量右室容积（EDV、ESV）、右室每分输出量（RVCO）、射血分数（3DRVEF）、面积变化分数（FAC）及三尖瓣环收缩期位移（TAPSE）。通过3D-STI获取游离壁整体纵向应变（3DGLS）。结果 ①与对照组比较,ESRD组及ESRD合并肺动脉高压组EDV、ESV、RVCO、RIMP显著增大,3DRVEF、TAPSE、FAC显著减低（P＜0.01）;ESRD组RVD1、RVD2、RVD3差异均无统计学意义（P＞0.05）;ESRD合并肺动脉高压组SV、PA、RAD、RVD1、RVD2均增大（P＜0.05）。与ESRD组比较,ESRD合并肺动脉高压组EDV、ESV、RVCO增大,3DRVEF、TAPSE、FAC减低（P＜0.05）。②3DGLS在对照组、ESRD组、ESRD合并肺动脉高压组依次显著减小（P＜0.01）。③相关性分析显示：3DGLS的绝对值与3DRVEF、TAPSE、FAC、RIMP均呈强相关（r=0.7701、0.6206、0.5922、-0.5475,P均＜0.01）。结论 实时三维超声及三维斑点追踪技术可以早期、敏感的定量评估LVEF保留的血液透析ESRD患者右心室收缩功能     

Inpatient rehabilitation outcomes in neoplastic spinal cord compression vs. traumatic spinal cord injury

Objective: To compare neurological and functional outcomes, and complications of patients with neoplastic vs traumatic spinal cord injury (SCI) after in-patient rehabilitation.Design: This study is a retrospective analysis.Setting: In-patient rehabilitation unit of a tertiary research hospital.Participants: A total of 252 patients with a SCI were included; 43 with neoplastic SCI (mean age: 60.9 ± 15.7 years, 60.5% were males) and 209 with traumatic SCI (mean age: 43.1 ± 16.8 years, 71.3% were males).Outcome measures: Comparisons were made of demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) and Functional Ambulation Categories (FAC) scores, length of stay (LOS), bladder independence, medical comorbidities and complications in both groups.Results: Patients with neoplastic SCI were significantly older than those with traumatic SCI (P < 0.01). No difference was present between the groups in terms of sex and lesion level (P > 0.05). Incomplete SCI was significantly higher in the neoplastic group when compared with the traumatic group (P < 0.01). The LOS was significantly shorter in the neoplastic group than traumatic group (34.8 ± 41.03 vs. 60.02 ± 53.1, P < 0.01). There were no differences in the admission FIM scores (69.3 ± 24.7 vs. 58.7 ± 18.9, P > 0.05), discharge FIM scores (82.1 ± 25.1 vs. 74.02 ± 23.3, P > 0.05) and FIM efficiencies (0.43 ± 0.72 vs. 0.36 ± 0.51, P > 0.05) for the neoplastic and traumatic groups, respectively. However, neoplastic SCI patients demonstrated lower FIM gains compared to traumatic patients (12.9 ± 11.9 vs. 15.4 ± 15.2, P < 0.05). During rehabilitation, urinary tract infection (48.4% vs. 69.4%) and decubitus ulcer (11.6% vs. 35.9%) were significantly more common in the traumatic group than the neoplastic group (P < 0.05).Conclusion: Neoplastic SCI patients who commonly present at rehabilitation units exhibit different characteristics from traumatic SCI patients but the rehabilitation results are similar. Similar functional development can be achieved in a shorter period of time with inpatient rehabilitation in the neoplastic SCI group.     

Influence of physiological and supraphysiological hyperinsulinemia on skin microcirculation in healthy volunteers

AIM: To examine skin perfusion in dependency on insulinemia in healthy subjects.METHODS: All volunteers were informed in detail about the procedures and signed informed consent. The protocol of this study was approved by the ethical committee. In our study, a two stage hyperinsulinemic euglycemic clamp was performed, with insulinemia 100 and 250 mIU/mL and glycemia 5.0 mmol/L (3% standard deviation). Before the clamp and in steady states, microcirculation was measured by laser Doppler flowmetry and transcutaneous oximetry and energy expenditure was measured by indirect calorimetry. Results (average and standard deviation) were evaluated with paired t-test.RESULTS: Physiological (50 mIU/L) insulinemia led to higher perfusion in both tests; hyperemia after heating to 44%-1848% (984-2046) vs 1599% (801-1836), P < 0.05, half time of reaching peak perfusion after occlusion release 1.2 s (0.9-2.6) vs 4.9 s (1.8-11.4), P < 0.05. Supraphysiological (150 mIU/L) insulinemia led to even higher perfusion in both tests; hyperemia after heating to 44%-1937% (1177-2488) vs 1599% (801-1836), P < 0.005, half time to reach peak perfusion after occlusion release 1.0 s (0.7-1.1) vs 4.9 s (1.8-11.4), P < 0.005. A statistically significant increase occurred in tissue oxygenation in both insulinemia. The difference in perfusion and oxygenation between physiological and supraphysiological hyperinsulinemia was not statistically significant.CONCLUSION: The post occlusive hyperemia test in accordance with heating test showed significantly increasing skin perfusion in the course of artificial hyperinsulinemia. This effect rises non-linearly with increasing insulinemia. Dependency on the dose was not statistically significant.     

Chronically Recurrent and Disseminated Tinea Faciei/Corporis—Autoinoculation from Asymptomatic Tinea Capitis Carriage

Abstract: We report clinical findings in a 12‐year‐old girl with long‐term recurrent and disseminated multiple eruptions of tinea faciei and tinea corporis, which persisted for 10 years. Mycological examination revealed the dermatophyte Trichophyton tonsurans in both scale samples from the body lesions and in brushing samples from her asymptomatic scalp, suggesting that she was an asymptomatic dermatophyte carrier on the scalp, and autoinoculation of the dermatophyte was responsible for the recurrent and disseminated tinea faciei/corporis.