Clinical profile of Parkinson's disease in the Gumei community of Minhang district,Shanghai

OBJECTIVE:

We examined the demographic and clinical profiles of Parkinson''s disease in Shanghai, China, to assist in disease management and provide comparative data on Parkinson''s disease prevalence, phenotype, and progression among different regions and ethnic groups.

METHODS:

A door-to-door survey and follow-up clinical examinations identified 180 community-dwelling Han-Chinese Parkinson''s disease patients (104 males, 76 females).

RESULTS:

The average age at onset was 65.16±9.60 years. The most common initial symptom was tremor (112 patients, 62.22%), followed by rigidity (38, 21.11%), bradykinesia (28, 15.56%) and tremor plus rigidity (2, 1.11%). Tremor as the initial symptom usually began in a single limb (83.04% of patients). The average duration from onset to mild Parkinson''s disease (Hoehn-Yahr phase 1–2) was 52.74±45.64 months. Progression from mild to moderate/severe Parkinson''s disease (phase≥3) was significantly slower (87.07±58.72 months; p<0.001), except for patients presenting initially with bradykinesia (53.83±24.49 months). Most patients (149/180, 82.78%) took levodopa with or without other drugs. The Hamilton Anxiety Scale revealed symptoms of clinical anxiety in 35 patients, and the Hamilton Depression Scale revealed depressive symptoms in 88 patients. The depressed or anxious subgroup (123 patients) demonstrated a significantly younger age at onset (55.54±7.68 years) compared with the overall mean (p<0.05).

CONCLUSION:

Unilateral limb tremor was the most common initial symptom, and motor function deteriorated slowly over ≈4−9 years. Earlier-onset patients experience greater psychiatric dysfunction.     

Characteristics of demyelinating Charcot-Marie-Tooth disease with concurrent diabetes mellitus

Purpose: Charcot-Marie-Tooth disease (CMT) is the most common type of inherited peripheral neuropathy and has a high degree of genetic heterogeneity. CMT with concurrent diabetes mellitus (DM) is rare. The purpose of this study is to explore the genetic, clinical and pathological characteristics of the patients with CMT and concurrent DM. Methods: We investigated gene mutations (the peripheral myelin protein 22 gene, myelin protein zero gene, lipopolysaccharide-induced tumor necrosis factor-α factor gene, early growth response gene and the neurofilament light chain gene loci) of a relatively large and typical Chinese family with CMT1 and concurrent DM2. From the literature, we also retrieved all reported families and single cases with CMT and concurrent DM. We comprehensively analyzed the characteristics of total 33 patients with CMT and concurrent DM, and further compared these characteristics with those of patients of diabetic peripheral neuropathy (DPN). Results: Patients with CMT and concurrent DM had some relatively independent characteristics and pathogenic mechanisms. So we designated that kind of characteristic demyelinating CMT which accompanies DM as Yu-Xie syndrome (YXS), a new specific clinical subtype of CMT. Conclusion: CMT is an etiologic factor of DM, even though the intrinsic association between CMT and DM still remains further exploration.     

Wheat - Dependent Exercise-Induced Anaphylaxis Occurred With a Delayed Onset of 10 to 24 hours After Wheat Ingestion: A Case Report

Wheat-dependent exercise-induced anaphylaxis (WDEIA) usually occurs 1 to 4 hours after wheat ingestion and the pathophysiology of WDEIA remains unknown. It is recommended that WDEIA patients refrain from exercise for 4 to 6 hours after wheat ingestion. We report a case of a 51-year-old man who experienced 5 anaphylaxis attacks; two of which occurred 10 to 24 hours after wheat ingestion and exercise. He has a history of chronic gastroenteritis that responds well to antihistamine drugs but not proton pump inhibitors (PPIs) and prokinetic agents. Abdominal CT results implied the possibility of superior mesenteric artery syndrome. We suggest that WDEIA occurs 6 hours after wheat ingestion in cases compounded by obstructive gastrointestinal diseases.     

Evaluation of the digestibility of steam-exploded wheat straw by ruminal fermentation,sugar yield and microbial structure in vitro

Wheat straw is considered an abundant lignocellulosic biomass source in China. However, its recalcitrance hinders the degradation of wheat straw by enzymes and microbes. In this study, we investigated the optimum steam explosion conditions of pretreated wheat straw by response surface methodology to improve its nutrition level as a feedstuff for the ruminant industry or as a feedstock for biofuel production. The highest volatile fatty acid (VFA) yield (30.50 mmol L⁻¹) was obtained at 2.3 MPa, 90 s and a moisture content of 36.46%. Under optimal conditions, steam explosion significantly altered the fermentation parameters in vitro. Ionic chromatography showed that pretreating wheat straw could improve the production of fermentable sugar, which was ascribed to the degradation of cellulose and hemicellulose. In addition, high throughput 16S rRNA amplicon sequencing analysis revealed that steam explosion changed the microbial community and enhanced the colonization of cellulolytic bacteria. Our findings demonstrated that steam explosion pretreatment could greatly improve the digestibility of wheat straw by facilitating sugar production and microbial colonization.

Wheat straw is considered an abundant lignocellulosic biomass source in China.     

酸蚀及微弧氧化对钛表面处理后与瓷结合强度的实验研究

目的：研究酸蚀和微弧氧化单独或联合应用对纯钛表面处理后进行烤瓷,观察其表面粗糙度并分析其钛瓷结合强度。方法：将50个纯钛试片（25mm×5mmx0．5mm）随机均分为5组,表面用碳化硅砂纸抛光后110μmA12O3进行喷砂处理,再进行喷砂、酸蚀、微弧氧化、酸蚀后微弧氧化及微弧氧化后酸蚀处理分别为A到E组,用粗糙度测试仪测量各组的粗糙度值并进行统计学分析,扫描电镜观察试件的表面形貌。行瓷粉烧结（厚度控制在1mm）,然后对钛瓷间的三点弯曲结合强度进行测试并进行统计学分析,用扫描电镜观察钛瓷分离面的的表面形貌。结果：酸蚀使纹路更清晰,粗糙度增加。C组纯钛表面形成许多孔洞,孔洞较大,大小基本一致。C组除大孔洞外还存在许多小孔洞,均匀致密。D组表面孔洞大小不一,较致密,存在凹陷,边缘不规则,个别相邻孔洞之间可见微裂纹。与喷砂相比,微弧氧化处理使纯钛与瓷的结合强度差异有统计学意义（P〈0．05）,而酸蚀处理的钛表面与瓷的结合强度增加,但与对照组差异无统计学意义（P〉0．05）。结论：酸蚀和微弧氧化联合处理与单独微弧氧化处理钛瓷间的结合强度差异无统计学意义,说明微弧氧化处理更利于钛瓷间的结合。     

结合锥形束CT评价两种镍钛器械预备老年人磨牙弯曲根管的效果

目的：比较镍钛器械Twisted Files（TF）和ProTaper在老年人磨牙弯曲根管预备中的临床应用效果。方法：选择2011年8月至2013年8月在我科门诊就诊的有弯曲根管的牙髓炎或根尖周炎的老年患者磨牙90颗,随机分成三组,每组30颗,T组和P组分别采用机用镍钛器械Twisted Files（TF）和ProTaper以冠向下技术预备根管,K组采用手用不锈钢K锉以逐步后退法预备根管,全部患牙均采用冷牙胶侧方加压技术充填。记录三组病例根管预备时间和器械折断数,根据治疗前、中、后的X线片评价根管预备和充填情况,通过锥形束C T记录预备前后距离根尖3mm处根管偏移值。结果：T组、P组均能保持原根管的弯曲和走向,根管预备的锥度和流畅度好,根管充填质量高,T组的偏移量比P组和K组的偏移量小,三组间差异有统计学意义（P〈0.05）。T组的操作时间比P组和K组短,三组间差异有统计学意义（P〈0.05）。预备过程中T组未发生器械折断,P组3例发生器械折断。结论：TF相对与Protaper用于预备老年人磨牙弯曲根管,效率较高,成形效果佳,较安全,更适合于狭窄弯曲的老年根管。     

二维斑点追踪成像评价心脏移植术后左室收缩同步性的价值探讨

目的应用二维斑点追踪成像评价临床状态稳定的心脏移植患者术后左室收缩同步性。方法选取20例心脏移植后无并发症且临床状态稳定的患者(心脏移植组),于移植术后3 d、1个月、3个月、6个月和1年行超声心动图检查;另选20例正常成人(对照组)。应用二维斑点追踪成像技术获取左室各节段纵向应变、径向应变及圆周应变达峰时间(Tls、Trs、Tcs),计算左室整体收缩期纵向应变、径向应变、环向应变达峰时间标准差(Tls-SD、Trs-SD、Tcs-SD)及达峰时间最大差值(Tls-dif、Trs-dif、Tcs-dif),并计算纵向应变延迟指数(LSDI),同时应用改良Simpson双平面法测量左室射血分数(LVEF)。比较心脏移植组各时间段与对照组间、心脏移植组各时点间上述参数的差异。结果心脏移植组术后3 d各应变参数均较对照组显著增高,差异均有统计学意义(均P<0.05);术后1个月Tls-SD与对照组比较差异有统计学意义(P<0.05)。心脏移植组术后LSDI、Tls-SD、Tls-dif呈逐渐降低趋势,且术后3 d与术后3个月、6个月、1年比较,差异均有统计学意义(均P<0.05);术后1个月Tls-SD与术后1年比较差异有统计学意义(P<0.05)。术后各时间段LSDI、Tls-SD和Tls-dif与LVEF均呈负相关(r=-0.523、-0.434、-0.401,均P<0.01),其中LSDI相关系数最高。结论临床状态稳定的心脏移植术后患者左室收缩功能存在不同步性,以术后3 d最为显著,在术后3个月左室收缩同步性得以恢复,并趋向正常。二维斑点追踪成像测得的LSDI、Tls-SD、Tls-dif可以客观评价心脏移植术后左室收缩同步性的变化,且以上参数与LVEF显著相关。     

59例成人EB病毒相关噬血细胞综合征临床特点和预后分析

目的:分析成人EB病毒相关噬血细胞综合征(EBV-HLH)患者的临床特点和预后危险因素,提高对该疾病的认识和诊治水平。方法:对2013年1月至2018年8月间南昌大学第一附属医院诊治的EBV-HLH 59例成人患者的临床特点和生存资料进行回顾性综合分析。结果:59例患者中以发热(100%)、肝功能异常(91.5%)最常见,皮疹(1.7%)、神经系统症状(3.4%)少见;血清铁蛋白升高(96.6%)、乳酸脱氢酶(LDH)升高(96.6%)、白蛋白(Alb)下降(93.2%)及可溶性CD25(s CD25)水平≥2400 U/ml(92.3%)均比较常见。本组患者中位生存时间为2.5±0.7个月,1、3、6、12个月总体生存率分别是69.5%±6.0%、44.7%±6.6%、23.9%±5.8%和19.7%±5.5%。生存资料单因素分析显示,初诊时EBV-DNA拷贝数≥5×10^5拷贝数/ml(P=0.028)、LDH水平≥600 U/L(P=0.012)、Plt计数<20×10^9/L(P=0.022)的患者预后更差,系统使用HLH-94/2004方案治疗能有效改善EBV-HLH患者预后(P<0.001)。多因素分析显示,LDH水平≥600 U/L(P=0.01)、Plt计数<20×1~09/L(P=0.013)、未系统使用HLH-94/2004方案治疗(P<0.001)均是影响患者生存时间的独立预后不良因素。结论:EBV-HLH患者病情凶险,早期死亡率高,初诊时EBV-DNA拷贝数≥5×10^5/ml、LDH水平≥600 U/L、Plt计数<20×10^9/L的患者预后不良,HLH-94/2004方案治疗能有效改善患者生存情况,应尽早系统治疗。