Long-term Efficacy of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease: A 5-year Follow-up Study in China

Background:

Subthalamic nucleus deep brain stimulation (STN DBS) is effective against advanced Parkinson''s disease (PD), allowing dramatic improvement of Parkinsonism, in addition to a significant reduction in medication. Here we aimed to investigate the long-term effect of STN DBS in Chinese PD patients, which has not been thoroughly studied in China.

Methods:

Ten PD patients were assessed before DBS and followed up 1, 3, and 5 years later using Unified Parkinson''s Disease Rating Scale Part III (UPDRS III), Parkinson''s Disease Questionnatire-39, Parkinson''s Disease Sleep Scale-Chinese Version, Mini-mental State Examination, Montreal Cognitive Assessment, Hamilton Anxiety Scale and Hamilton Depression Scale. Stimulation parameters and drug dosages were recorded at each follow-up. Data were analyzed using the ANOVA for repeated measures.

Results:

In the “off” state (off medication), DBS improved UPDRS III scores by 35.87% in 5 years, compared with preoperative baseline (P < 0.001). In the “on” state (on medication), motor scores at 5 years were similar to the results of preoperative levodopa challenge test. The quality of life is improved by 58.18% (P < 0.001) from baseline to 3 years and gradually declined afterward. Sleep, cognition, and emotion were mostly unchanged. Levodopa equivalent daily dose was reduced from 660.4 ± 210.1 mg at baseline to 310.6 ± 158.4 mg at 5 years (by 52.96%, P < 0.001). The average pulse width, frequency and amplitude at 5 years were 75.0 ± 18.21 μs, 138.5 ± 19.34 Hz, and 2.68 ± 0.43 V, respectively.

Conclusions:

STN DBS is an effective intervention for PD, although associated with a slightly diminished efficacy after 5 years. Compared with other studies, patients in our study required lower voltage and medication for satisfactory symptom control.     

Clinical Characteristics,Radiological Features and Gene Mutation in 10 Chinese Families with Spinocerebellar Ataxias

Background:

Spinocerebellar ataxias (SCAs) are a group of neurodegenerative disorders that primarily cause the degeneration in the cerebellum, spinal cord, and brainstem. We study the clinical characteristics, radiological features and gene mutation in Chinese families with SCAs.

Methods:

In this study, we investigated 10 SCAs Chinese families with SCA1, SCA3/Machado–Joseph disease (MJD), SCA7, SCA8. There were 27 people who were genetically diagnosed as SCA, of which 21 people showed clinical symptoms, and 6 people had no clinical phenotype that we called them presymptomatic patients. In addition, 3 people with cerebellar ataxia and cataracts were diagnosed according to the Harding diagnostic criteria but failed to be recognized as SCAs on genetic testing. Clinical characteristic analyses of each type of SCAs and radiological examinations were performed.

Results:

We found that SCA3/MJD was the most common subtype in Han population in China, and the ratio of the pontine tegmentum and the posterior fossa area was negatively correlated with the number of cytosine-adenine-guanine (CAG) repeats; the disease duration was positively correlated with the International Cooperative Ataxia Rating Scale score; and the CAG repeats number of abnormal alleles was negatively correlated with the age of onset.

Conclusions:

Collectively our study is a systematic research on SCAs in China, which may help for the clinical diagnosis and prenatal screening of this disease, and it may also aid toward better understanding of this disease.     

Efficacy and Safety of Avandamet or Uptitrated Metformin Treatment in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Alone: A Multicenter,Randomized, Controlled Trial

Background:

At present, China has listed the compound tablet containing a fixed dose of rosiglitazone and metformin, Avandamet, which may improve patient compliance. The aim of this study was to evaluate the efficacy and safety of Avandamet or uptitrated metformin treatment in patients with type 2 diabetes inadequately controlled with metformin alone.

Methods:

This study was a 48-week, multicenter, randomized, open-labeled, active-controlled trial. Patients with inadequate glycaemic control (glycated hemoglobin [HbA1c] 7.5–9.5%) receiving a stable dose of metformin (≥1500 mg) were recruited from 21 centers in China (from 19 November, 2009 to 15 March, 2011). The primary objective was to compare the proportion of patients who reached the target of HbA1c ≤7% between Avandamet and metformin treatment.

Results:

At week 48, 83.33% of patients reached the target of HbA1c ≤7% in Avandamet treatment and 70.00% in uptitrated metformin treatment, with significantly difference between groups. The target of HbA1c ≤6.5% was reached in 66.03% of patients in Avandamet treatment and 46.88% in uptitrated metformin treatment. The target of fasting plasma glucose (FPG) ≤6.1 mmol/L was reached in 26.97% of patients in Avandamet treatment and 19.33% in uptitrated metformin treatment. The target of FPG ≤7.0 mmol/L was reached in 63.16% of patients in Avandamet treatment and 43.33% in uptitrated metformin treatment. Fasting insulin decreased 3.24 ± 0.98 μU/ml from baseline in Avandamet treatment and 0.72 ± 1.10 μU/ml in uptitrated metformin treatment. Overall adverse event (AE) rates and serious AE rates were similar between groups. Hypoglycaemia occurred rarely in both groups.

Conclusions:

Compared with uptitrated metformin, Avandamet treatment provided significant improvements in key parameters of glycemic control and was generally well tolerated. Registration number: ChiCTR-TRC-13003776.     

胃肠道弥漫大B细胞淋巴瘤CD10、Bcl-6和VEGF与预后的相关性研究

目的：探讨原发于胃肠道的弥漫大 B 细胞淋巴瘤（PGI-DLBCL）的临床特征,CD10、Bcl-6和 VEGF 表达,分析其与预后的相关性。方法收集66例病理确诊原发 PGI-DLBCL 患者的临床资料,采用免疫组化法检测肿瘤组织CD10、Bcl-6及 VEGF 表达水平;应用 Hans 分型法、Kaplan-Meier 法、Log-rank 检验对患者进行分型,分析临床特征、CD10、Bcl-6及 VEGF 表达与无进展生存期（ PFS）相关性。结果66例患者,原发胃部36例（54.5%）,原发肠道30例（45.5%）。生发中心型（GCB）39例（59.1%）,非生发中心型（non-GCB 型）27例（40.9%）。肿瘤分期、国际预后指数（IPI）评分与 PFS 呈负相关性（P <0.05）。GCB 中位 PFS 为21.50个月,non-GCB 中位 PFS 12.00个月。Bcl-6阳性表达29例（43.9%）,CD-10阳性表达23例（34.8%）,VEGF 阳性表达29例（43.9%）;单因素分析结果提示 CD10、Bcl-6阳性表达与 PFS 呈正相关性（ P <0.05）,而 VEGF 阳性表达与PFS 呈负相关性（P <0.05）;CD10、Bcl-6、VEGF 表达与临床特征之间无明显相关性。Cox 多因素预后分析提示治疗结果、Bcl-6及 VEGF 为影响生存时间的独立影响因素。结论PGI-DLBCL 是一类高侵袭性、高特异性的恶性肿瘤,Hans分型、肿瘤分期、IPI 评分、VEGF、CD10、Bcl-6表达均与其预后有相关性。     

国内外结直肠癌早诊早治现状

结直肠癌(CRC, colorectal cancer)是世界范围内常见的恶性肿瘤，根据2012年全球肿瘤数据统计，其在男性恶性肿瘤中排名第三，在女性中排名第二，是人类重要的疾病负担之一。以往认为，CRC在中国的发病率相对偏低，但随着中国居民饮食结构的改变，CRC在中国的发病率持续上升，在北京上海等部分大城市已经成为最常见的消化系统恶性肿瘤，整个东亚地区CRC的发病率已经逐渐接近于北美地区。2013年的中国癌症数据统计显示，CRC的发病率已经超过了食管癌，成为目前消化系统第三常见的恶性肿瘤。虽然目前数据统计显示，中国CRC的发病率居于胃癌和肝癌之后，但是根据标准人口测算时，我国CRC发病率趋势居于所有消化系统恶性肿瘤之首，随着我国社会人口老龄化的不断加速和饮食结构的持续改变，CRC的发病率将进一步升高，很可能超越胃癌和肝癌成为我国最常见的消化系统恶性肿瘤。因此，降低我国CRC的发病率和死亡率，成为亟待解决的重大公共卫生问题。研究数据显示，结直肠从正常黏膜转变为晚期恶性肿瘤，中间会经历息肉、腺瘤、上皮内瘤变和早癌等多个病理过程，中间期限达15到20年，如果能及时这段时间内进行筛查，发现这些早期癌前病变，就能够大大的降低CRC的发病率和死亡率。同大多数恶性肿瘤一样，CRC的预后与诊治的时机密切相关，早期诊断和治疗能够大大的提高患者的五年生存率。但是，我国CRC患者的五年生存率却一直偏低，不仅明显落后于欧美等发达国家，与日韩等国也有不小的差距，早诊早治的意识严重偏低，到目前为止，尚没有全国范围内的大数据来支撑和反映我国CRC的诊治现状。     

Impact of the supine position versus left horizontal position on colonoscopy insertion: a 2-center,randomized controlled trial

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保定市1994～2004年人间布氏菌病流行特点及分析

目的 分析保定市1994～2004年人间布氏菌病流行特点，为布氏菌病防治提供科学依据。方法 收集1994～2004年本市布氏菌病患者个案资料进行分析。结果 发病人数显著增加；发病以从事羊只饲养、屠宰、皮毛加工人员为主；4～8月份为发病高峰；发病至确诊间隔时间长，及时诊断率低。结论 保定市人间布氏菌病疫情有上升趋势，局部地区存在布氏菌病暴发流行的可能性。     

青海省碘缺乏病区7—16岁儿童青少年碘代谢和垂体—甲状腺功能的研究

本文对青海省碘盐防治十年后的碘缺乏病区7～16岁儿童青少年进行了碘代谢和垂体-甲状腺功能的研究。结果表明:尿碘与TSH及T_4无明显相关关系(P>0.05),病区尿碘均值为110.22±90.40μg/L,说明病区人群的缺碘状态已得到基本纠正。但病区存在有一部分尿碘值低于正常值以及亚临床甲低的人群,提示该部分人群还处在摄碘相对不足的状态,应给予碘剂治疗加以纠正。     

Human recombinant-B-type natriuretic peptide protect ventricular function and structure in ST-elevation myocardial infarction

Background: ST-elevation myocardial infarction (STEMI) is the most serious clinical type of coronary artery disease (CAD), which will lead to a loss of contractile function asa result of adverse left ventricular (LV) remodeling. Post-myocardial infarction remodeling is detrimental to the left ventricular function, which is strongly related to clinical outcome,including heart failure and cardiac death. And our study was designed toassess the efficacy of 72-hour IV infusion of rh-BNP therapy in STEMI patients with or without successful primary PCI, in preventing adverse LV remodeling and preserving LV function. Methods: 100 patients diagnosed as STEMI combined with acute heart failure (Killip classification ≥2) were recorded. And they were dividedinto “rh-BNPtreatment group” (n=50) and “control group” (n=50). In addition to conventional heart failure therapy, patients in the rh-BNP group receivedrh-BNPinfusion for 72 hours. All patients were followed up at 3 month after discharge. Their medical history was taken, as well as the presence or absence of relevant symptoms. 6-minute walking test, as well as echocardiographic indexes were recorded to evaluate the improvement of cardiac function. Results: The data analysis about demographic comparison, including those related complicated diseases among groups showed no significant difference. After the follow-up, the indicators were all better than baseline among four subgroups (all P<0.001). Results showed that rh-BNP was able to significantly reduce the NT-pro BNP levels (P<0.001), decrease LVESD (P<0.01), and increase LVEF (P<0.05). The difference of 6WMT between two groups was significant (P<0.001). According to the classification of 6WMT, the multivariate Cox regression showed that the usage of rh-BNP was an independent predictor for 6WMT (OR 0.478, 95% CI, 0.290-0.787), while it may not for MACE (OR 1.762, 95% CI, 0.793-3.913). Conclusions: Although the use of rh-BNP was not an independent risk factor in prediction of MACE in our study, the current data still showed that rh-BNP is a useful prognosis factor of 6WMT in the STEMI patients. The protection of ventricular function and structure in STEMI patients is affirmative.