Late-onset epilepsy and occult cerebrovascular disease

The interface between cerebrovascular disease (CVD) and epilepsy is complex and multifaceted. Late-onset epilepsy (LOE) is increasingly common and is often attributed to CVD, and is indeed associated with an increased risk of stroke. This relationship is easily recognizable where there is a history of stroke, particularly involving the cerebral cortex. However, the relationship with otherwise occult, subcortical CVD is currently less well established yet causality is often invoked. In this review, we consider the diagnosis of LOE in clinical practice—including its behaviour as a potential mimic of acute ischemic stroke and transient ischemic attack; evidence for an association between occult CVD and LOE; and potential mechanisms of epileptogenesis in occult CVD, including potential interrelationships between disordered cerebral metabolism and perfusion, disrupted neurovascular unit integrity, blood–brain barrier dysfunction, and inflammation. We also discuss recently recognized issues concerning antiepileptic drug treatment and vascular risk and consider a variety of less common CVD entities associated with seizures.     

Kinetics of peripheral blood mononuclear cell mobilization with chemotherapy and/or granulocyte-colony-stimulating factor: implications for yield of hematopoietic progenitor cell collections

BACKGROUND: Peripheral blood progenitor cells (PBPCs) are commonly collected and used to reconstitute hematopoiesis after high-dose chemotherapy. However, strategies for optimal collection and assessment of leukapheresis components are not standardized. STUDY DESIGN and METHODS: Hematopoietic progenitor cell assays were performed on 369 leukapheresis components collected from 95 patients who had received doxorubicin-based chemotherapy and/or granulocyte-colony-stimulating factor (G-CSF). Precollection patient hematologic values, leukapheresis collection values, component hematopoietic progenitor cell assays, and patient outcome measures were summarized. The kinetics of mononuclear cell (MNC) and PBPC mobilization were assessed among four patient groups. RESULTS: Patient group was a significant predictor of the peripheral blood MNC count on the day of collection (p<0.0001), and that value was a significant predictor of granulocyte-macrophage– colony-forming unit (CFU-GM) yield (p<0.0001). This relationship between the peripheral blood MNC count on the day of collection and CFU- GM yield differed according to patient group (p<0.0001). CFU-GM made up a larger fraction of peripheral blood MNCs collected from patients who received chemotherapy plus G-CSF than collected from those who received G-CSF alone. Moreover, the peripheral blood MNC count and the corresponding CFU-GM yield increased significantly on consecutive days of collection in patient groups receiving chemotherapy and G-CSF but were unchanged or decreased in patients receiving G-CSF alone. CONCLUSION: The relationship between peripheral blood MNC count and leukapheresis component CFU-GM yield differed significantly between patients who received chemotherapy and G-CSF and those who received G- CSF alone for the mobilization of PBPCs. Patient peripheral blood MNC count and component CFU-GM yield are useful for both assessing and suggesting revisions to PBPC mobilization and collection strategies.     

肝癌介入诊疗中DSA血流动力学参数分析初步探讨

目的探讨肝癌TACE介入栓塞前肝动脉造影图像上癌灶、癌旁肝组织、背景肝组织之间血流动力学相关参数的差异性。方法本组共34例,男28例,女6例,均为经临床诊断原发性肝癌后第一次行介入诊疗。介入栓塞治疗前均先行肝固有动脉插管造影,采用高压注射器团注对比剂（370mgl／m1）15ml,流率5ml／s,注射后延时0．5s曝光,以4帧／s（fps）帧率持续采集图像15s,获取60（4x15）幅图像。图像处理采用自主开发的图像处理软件DSAanalysis1．0。分别在癌灶的肿瘤染色区、癌旁肝组织及背景肝组织等区域各选定兴趣区（ROI）,并生成各区域ROI的时间一密度曲线（TDC）,对各TDC进行定量分析,获得与血流动力学相关的参数并对比,相关的参数包括：视频密度增量峰值（AXPV）、达峰时间（TP）、显影持续时间（TD）、TDC升支及降支最大斜率（KmaxU及KmaxD）。结果癌灶、癌旁肝组织、背景肝组织的TD分别为12．97s±0．89、7．75s±0．89、4．99s±0．37;KmaxD分别为36．0s^-1±8．2、90．8s^-1±24．3和142．6S^-1±26．4s。癌灶、癌旁肝组织、背景肝组织的TD及KmaxD两两对比均具有显著性的差异（P〈0．01）。而其他参数三者之间差异无统计学意义（P〉0．05）。结论通过对DSAanalysis1．0软件获得的TDC进行分析,可获得与血流动力学相关参数值,其中TD、KmaxD可在一定程度上反映癌灶、癌旁肝组织及背景肝组织的血流动力学差异。     

Total but not resting energy expenditure is increased in infants with ventricular septal defects

OBJECTIVE: The purpose of this study was to determine the effect of left-to-right shunting on the resting energy expenditure (REE), total energy expenditure (TEE), and energy intake in a group of 3- to 5-month-old infants with moderate to large unrepaired ventricular septal defects (VSDs) compared with age-matched, healthy infants. METHODS: Eight infants with VSDs and 10 healthy controls between 3 to 5 months of age participated in the study. Indirect calorimetry was used to measure REE and the doubly-labeled water method was used to measure TEE and energy intake. An echocardiogram and anthropometric measurements were performed on all study participants. Daily urine samples were collected at home for 7 days. Samples were analyzed by isotope ratio mass spectrometry. Data were compared using analysis of variance. RESULTS: No significant differences were found in REE (VSD, 42.2 +/- 8.7 kcal/kg/d; control, 43.9 +/- 14.1 kcal/kg/d) or energy intake (VSD, 90.8 +/- 19.9 kcal/kg/d; control, 87.1 +/- 11.7 kcal/kg/d) between the groups. The percent total body water was significantly higher in the VSD infants and the percent fat mass was significantly lower. TEE was 40% higher in the VSD group (VSD, 87.6 +/- 10.8 kcal/kg/d; control, 61.9 +/- 10.3 kcal/kg/d). The difference between TEE and REE, reflecting the energy of activity, was 2.5 times greater in the VSD group. CONCLUSIONS: REE and energy intake are virtually identical between the two groups. Despite this, infants with VSDs have substantially higher TEE than age-matched healthy infants. The large difference between TEE and REE in VSD infants suggests a substantially elevated energy cost of physical activity in these infants. These results demonstrate that, although infants with VSDs may match the energy intake of healthy infants, they are unable to meet their increased energy demands, resulting in growth retardation.     

中西医结合治疗老年高脂血症

目的：探讨中西医结合治疗高脂血症的临床疗效。方法：符合高脂血症标准的老年患者120例，随机分为A、B2组各60例，A组采用益肾化淤、利湿化浊为主的中药及西药辛伐他汀片治疗；B组则单纯用辛伐他汀片治疗。治疗前及治疗4周后2组均行全套血脂水平测定。结果：与B组比较，A组血清总胆固醇（TC）及甘油三酯（TG）均明显下降，HDL明显上升（均P〈0．05）；A组临床控制率明显高于B组（P〈0．05）；治疗后A组患者未见肝功能损害，B组转氨酶及转肽酶轻度异常，2例。停药3个月后，A组复发率低于B组（2．2％、8．8％，P〈0．05）。结论：中西医结合治疗老年高脂血症的临床效果明显优于单一的一种治疗方法，值得临床进一步推广应用。     

Localization of epitopes for human factor VIII inhibitor antibodies by immunoblotting and antibody neutralization

Human factor VIII(FVIII) inhibitors are pathologic, circulating antibodies that inactivate FVIII. We have examined the location of epitopes on the FVIII protein for inhibitors from hemophilia A and nonhemophilic individuals. The inhibitors were of type I or type II in the kinetics of their inactivation of FVIII. A cDNA clone of human FVIII was used to express defined FVIII protein fragments in Escherichia coli for immunoblotting with inhibitor plasma. An epitope for 18 heavy-chain inhibitors was localized to the aminoterminal 18.3 Kd of the A2 domain. Two of these inhibitors also recognized an epitope located between A1 and A2 domains. Similarly, an epitope for 23 light- chain inhibitors was localized to the C2 domain. Weaker epitopes for 13 of the same inhibitors within the C1 and C2 domains were also observed. Four of the 23 inhibitors in addition bound strongly to the A3 domain. Most inhibitors (22 of 23) were neutralized in vitro only by the FVIII fragments to which they bound on immunoblots; however, one inhibitor that was neutralized by a fragment containing the A1 domain did not bind to it on immunoblots. Conversely, 3 of 3 inhibitors that bound to the A3 domain and 5 of 15 that bound to the A2 domain were not neutralized by the corresponding fragments. The epitope specificity of an inhibitor did not depend on its source or type. Our results show that FVIII inhibitors bind to limited areas within the heavy and light chains of FVIII. Some inhibitor plasmas contain additional antibodies that may not be inhibitory.     

日本血吸虫SjCa8基因的原核表达及其免疫学特征分析

目的表达和纯化日本血吸虫钙结合蛋白(SjCa8),研究其免疫学特征。方法重组质粒pET32a ( )-SjCa8经诱导表达后,获取纯化蛋白SjCa8,利用ELISA、Western-blot和动物保护性实验检测SjCa8的免疫学特征。结果成功获取了纯化蛋白SjCa8,该蛋白能免疫识别血吸虫感染小鼠血清和血吸虫病患者血清。SjCa8免疫Balb/c小鼠可获得较高滴度的特异性抗体,诱导宿主产生35．31%的减虫率和35．68%的减卵率。结论纯化蛋白SjCa8具有良好的免疫原性和免疫反应性,具有作为血吸虫病免疫诊断和疫苗候选分子的研究价值。