The role of adrenal computerized tomography in endocrinopathies. Cushing's syndrome

A comparison was made between the adrenal or hypophyseal histology and the CT finding of adrenal glands in 18 Cushing patients in an assessment of CT as a preliminary screening measure prior to hormone studies for the detection of subjects with adrenal tumours, and hence candidates for adrenalectomy. The CT finding were: 8 tumours (7 adenomas and 1 carcinoma), 5 hyperplasia, 5 NAD. All the adrenal tumours (diameter 18-69 mm) were correctly identified. The only distinctive feature of the carcinoma was its size. A CT diagnosis of adrenal tumour can be regarded as conclusive. Pictures indicative of hyperplasia or absence of alterations, however, must be supplemented by hormone tests and (if necessary) CT of the hypophysis.     

Venous digital subtraction angiography in the evaluation of renovascular hypertension

The study of renovascular hypertension (R.V.H.) presently requires multiple non invasive examinations in order to select between patients with R.V.H. or other kind of hypertension, before resorting to angiography. The use of venous digital subtraction angiography (V.D.S.A.) may change this diagnostic flow-chart. For this purpose, 100 patients with clinical and laboratory data suspect of R.V.H. underwent V.D.S.A. Compared to angiography, V.D.S.A. showed a 100% sensitivity and 93% specificity. Since the sensitivity and specificity of the non invasive techniques vs. V.D.S.A. in the same series was always lower, V.D.S.A. may be proposed as the first examination in the study of R.V.H. The arterial route for D.S.A. is generally not required for diagnostic purposes.     

Baseline cellular HIV DNA load predicts HIV DNA decline and residual HIV plasma levels during effective antiretroviral therapy

Cellular human immunodeficiency virus type 1 (HIV-1) DNA may be considered a marker of disease progression with significant predictive power, but published data on its correlation with plasma HIV RNA levels and CD4 counts in acute and chronic patients are not conclusive. We evaluated a cohort of 180 patients naïve for antiretroviral therapy before the beginning of treatment and after a virological response in order to define the indicators correlated with HIV DNA load decrease until undetectability. The following variables were evaluated as continuous variables: age, CD4 cell count and log₁₀ HIV DNA level at baseline and follow-up, and baseline log₁₀ HIV RNA level. Primary HIV infection at the start of therapy, an HIV RNA level at follow-up of <2.5 copies/ml, origin, gender, and transmission risk were evaluated as binary variables. The decline of HIV DNA values during effective therapy was directly related to baseline HIV DNA and HIV RNA values, to an increase in the number of CD4 cells, and to the achievement of an HIV RNA load of <2.5 copies/ml. An undetectable cellular HIV DNA load was achieved by 21.6% of patients at the follow-up time point and correlated significantly with lower baseline cellular HIV DNA values and with being in the primary stage of infection when therapy started. In conclusion, early treatment facilitated the achievement of undetectable levels of plasma viremia and cellular HIV DNA and a better recovery of CD4 lymphocytes. HIV DNA levels before and during highly active antiretroviral therapy may be used as a new tool for monitoring treatment efficacy.     

神经调节素对阿尔茨海默病大鼠模型海马细胞凋亡和核转录因子κB表达的影响

目的 研究神经调节素1β( neuregulin 1β,NRG1β)对β-淀粉样蛋白1-40(beta-amyloid protein,Aβ1-40)所致的模拟阿尔茨海默病模型大鼠空间学习记忆能力、神经元凋亡、核转录因子κB( nuclear factor kappa B,NFκB)表达的影响,探讨NRG改善学习记忆能力的作用机制.方法 成年健康雄性Wistar 大鼠30只,随机数字表法分为对照组、模型组和治疗组,每组10只,经侧脑室微量注射Aβ1-40建立实验性阿尔茨海默病模型大鼠,经侧脑室注射NRG1β(0.3μg·kg-1)干预治疗.各组大鼠实验前及造模7d后、治疗14d后均用Y型迷宫检测大鼠学习和记忆功能,利用HE染色观察海马神经细胞的结构变化,原位TUNEL法检测海马神经细胞凋亡,免疫组织化学法检测海马神经细胞NFκB的表达.结果 模型组大鼠学习能力[ (57.50±1.58)次]和记忆能力[(7.20±1.03)次]较对照组学习[(59.50±2.79)次]和记忆能力[(7.50±1.08)次]明显下降(=20.36,5.28,P＜0.05),海马区神经细胞排列稀疏、紊乱,有明显神经元脱失,TUNEL阳性细胞数明显增多、NFκB表达增加(P＜0.05).NRG1β治疗组大鼠学习记忆能力[ (67.70±4.90)次,(5.80±0.63)次]及细胞结构较模型组[(79.10±4.12)次,(4.40±0.69)次]显著改善( t=5.63,4.69,P＜0.05).相对于模型组[(41.10±7.95)次,(29.30±7.24)个],NRG1β治疗组NFκB表达(25.90±6.67)明显减弱、细胞凋亡数量[(23.50±3.89)个]明显减少(t=4.63,2.23,P＜0.05).结论 NRG1β能抑制海马神经细胞NFκB表达,减少细胞凋亡,从而改善阿尔茨海默病大鼠的学习和记忆能力.     

Alcohol related conditions represent a major psychiatric problem in emergency departments

Background

Alcoholism represents a huge socioeconomic burden in most developed societies.

Methods

In order to determine the impact of conditions associated with alcohol abuse on emergency care, in 2002 all patients with alcohol related pathology presenting to the emergency department (ED) of a large urban university hospital in Germany were assessed.

Results

Of 2194 patients seen by psychiatrists in the ED, the 613 cases associated with alcohol abuse represented the largest diagnostic group (30.7%). Within this group, alcohol intoxication was the most frequent diagnosis (71.4%). Patients with an alcohol related condition needed treatment by different medical specialities and required diagnostic procedures significantly more often and consequently stayed significantly longer in the ED than patients with other psychiatric presentations.

Conclusions

The generally underestimated problem of alcohol abuse in Germany demands an excessive amount of manpower and resources in EDs, where a high yet expensive standard of care is provided. Against this background, how far this burden can be reduced, both in EDs and in society in general, is discussed.     

糖皮质激素反应性与急性淋巴细胞白血病患儿预后的关系

目的评价糖皮质激素反应性与急性淋巴细胞白血病患儿持续缓解、复发、死亡等预后的关系。方法收集中山大学附属第一医院2008年6月至2011年12月146例住院急性淋巴细胞白血病患儿,通过泼尼松诱导试验初步判断激素的反应性,根据激素反应性不同分组并结合相应的实验室指标:初始外周血白细胞数,初始外周血幼稚淋巴细胞数,外周血幼稚淋巴细胞百分比,融合基因MLL及BCR/ABL,化疗后第8、26天骨髓象,从而评价急性淋巴细胞白血病患儿糖皮质激素反应性与预后的关系。结果 146例患儿中,糖皮质激素反应性敏感(PR+)者为121例(82.88%),其中107例(88.43%)处于持续缓解状态,复发11例,死亡2例,放弃治疗1例。糖皮质激素反应性不敏感(PR-)者为25例(17.12%),其中持续缓解13例,复发6例,死亡5例,放弃治疗1例。PR+组复发死亡率明显低于PR-组,其中两组患儿的初始外周血白细胞数、初始外周血幼稚淋巴细胞数、外周血幼稚淋巴细胞百分比、化疗后第8、26天骨髓象、危险度的分级差异有统计学意义,且复发组的初始幼稚淋巴细胞百分比明显高于未复发组。结论通过泼尼松诱导试验结合一系列实验室指标可判断糖皮质激素的反应性,从而指导疾病的治疗和预测疾病转归。