Neuritic plaques in the Lewy body variant of Alzheimer disease lack paired helical filaments

The Lewy body variant of Alzheimer disease (LBV) is a distinct category of dementia which, unlike pure diffuse Lewy body disease (DLBD), meets clinical and neuropathologic criteria for Alzheimer disease (AD) but differs from pure AD in having a neocortical predominance of diffuse and neuritic plaques (NP), with very few neurofibrillary tangles (NFT). We investigated the immunoreactivity of NP with a monoclonal antibody against paired helical filaments (PHF) composed of phosphorylated microtubule associated protein tau. With routine thioflavin-S preparations, 12 LBV and 14 AD cases had similar numbers of NP, but the LBV had significantly (P<0.05) fewer NFT per microscopic field in the midfrontal cortex. Among subjects with midfrontal NFT, 81–84% of NP in AD and LBV were anti-PHF positive. Among subjects without midfrontal NFT, 52% of NP in AD but only 12% of NP in LBV cases were anti-PHF positive (P<0.05). LBV differs from AD in that its NP generally do not contain PHF, unless they are accompanied by neocortical NFT.     

糖尿病与非糖尿病患者冠状动脉斑块分布及负荷比较

目的　探讨糖尿病与非糖尿病患者冠状动脉斑块分布及狭窄程度的差异。方法　263例冠心病和可疑冠心病患者,根据糖尿病病史,分为糖尿病组（92例）和非糖尿病组（171例）,所有患者均行双源CT冠状动脉血管成像（DSCTA）,对冠状动脉斑块（混合斑块、钙化斑和非钙化斑）进行计数。结果　糖尿病组左前降支（LAD）（P0.007）、右冠状动脉（RCA）（P0.041）钙化积分和总钙化积分（T　scores）（P0.027）明显大于非糖尿病组;糖尿病组冠状动脉斑块（P<0.001）明显多于非糖尿病组,以混合斑块（P<0.001）和非钙化斑块（P0.045）为主;糖尿病组病变的冠状动脉支数（P<0.001）及阻塞性斑块（P<0.001）明显多于非糖尿病组。结论　与非糖尿病患者比较,有症状的糖尿病患者冠状动脉阻塞性斑块的发生率更高,冠状动脉钙化程度更重,冠状动脉斑块负荷更重,以混合斑块和非钙化斑块为主,但是仍需要进一步的研究对此研究结果验证。     

温控气体损伤建立兔动脉粥样硬化易损斑块模型

目的利用持续恒定低温气体损伤血管内皮,结合高脂饮食,建立兔颈动脉粥样硬化易损斑块动物模型。方法新西兰雄性白兔24只,3月龄,随机分为空白对照组、假手术组和温控气体损伤组,每组8只。高脂饮食喂养1周后对温控气体损伤组利用低温气体给予血管内膜损伤处理,假手术组单纯给予有创手术操作,术后两组均继续给予高脂饮食12周;空白对照组给予持续普通饮食。术后13周处死动物,取血管行HE、Masson、弹力纤维、油红O染色,观察血管形态,并做小鼠抗兔巨噬细胞抗体11免疫组织化学染色。结果温控气体损伤组可见薄的纤维帽、大脂质核心,内膜有巨噬细胞及泡沫细胞浸润,部分内皮脱落,斑块出现裂隙,局部小血栓形成,形成典型的易损斑块;假手术组多表现为内膜增生,部分存在小斑块,内皮下见泡沫细胞浸润,符合脂纹期改变,为初级斑块;空白对照组未见斑块形成。结论利用恒定低温气体损伤兔颈动脉内膜结合高脂饮食可建立典型的易损斑块模型,且方便易行。     

活化T细胞核因子c1检测联合血管内超声在冠心病风险评价中的作用

目的以血管内超声(IVUS)分析为参照,探讨活化T细胞核因子c1(NFATc1)对不稳定性斑块的预测意义。方法 183例冠心病患者根据IVUS结果分为不稳定性斑块组(98例)和稳定性斑块组(85例),另选46例冠状动脉造影结果阴性患者为对照组。流式细胞术检测淋巴细胞内NFATc1表达水平,通过受试者工作曲线(ROC)分析其对不稳定性斑块的诊断意义。结果冠心病患者NFATc1水平明显高于对照组,其中不稳定性斑块组NFATc1水平高于稳定性斑块组,NFATc1受试者工作曲线下面积为0.796,P=0.01,最佳界值平均荧光强度为17.5。结论 NFATc1是不稳定性斑块的活动性指标,能够评价冠心病风险,从而进一步预测急性冠状动脉事件的发生。     

Focal pathology in the Edinger-Westphal nucleus explains pupillary hypersensitivity in Alzheimer’s disease

Patients who suffer from Alzheimer’s disease (AD) and a sub-population of community-dwelling elders show an exaggerated pupillary reaction to dilute tropicamide, a cholinergic antagonist. This finding may serve as an early diagnostic marker of AD. Here we report a likely pathological basis for this hypersensitive pupillary response. Our observations indicate that the Edinger-Westphal nucleus (EW), a known center for the control of pupillary function, is a selective target of Alzheimer pathology early in the course of the disease. In all AD cases examined, the EW contained plaques and tangles. In contrast, the adjacent somatic portion of the oculomotor complex was virtually spared of pathology. Early pathology in the EW is likely to initiate a cascade of events that may give rise to pupillary hypersensitivity. Received: 21 July 1998 / Revised: 27 October 1998 / Accepted: 3 November 1998     

Die Silberkornkrankheit – Abgrenzung zur Alzheimer’schen Erkrankung

Zusammenfassung Die Silberkornkrankheit ist eine Demenzform des hohen Alters, die feingeweblich durch das Vorhandensein zahlreicher Silberk?rner und sogenannter „coiled bodies” charakterisiert ist. Beide Ver?nderungen sind im limbischen System (vor allem CA1-Abschnitt des Hippocampus, entorhinale Rinde, Mandelkern) und im Hypothalamus lokalisiert. Die Silberk?rner lassen sich mit Hilfe geeigneter Versilberungsmethoden einfach darstellen und sind gut von neurofibrill?ren L?sionen der Alzheimer-Erkrankung (Tangles und Threads) abgrenzbar. Obwohl die Silberkornkrankheit morphologisch ein gut definiertes Krankheitsbild darstellt, ist deren nosologische Zuordnung noch weitgehend unklar. Dies ist vor allem auf den Umstand zurückzuführen, da? sich in Gehirnen von Silberkornf?llen neben den für diese Erkrankung typischen Ver?nderungen praktisch immer L?sionen vom Alzheimer-Typ finden. Einzelne Autoren meinen deshalb, die Silberkornkrankheit sei lediglich eine Variante der Alzheimer-Erkrankung. Ziel des vorliegenden übersichtsartikels ist es, die Silberkornkrankheit einer breiten Leserschaft n?herzubringen. Zu diesem Zweck berichten wir über die von uns an insgesamt 90 F?llen erhobenen morphologischen, immunhistochemischen, klinisch-pathologischen und genetischen Befunde. Unsere Resultate, zusammen mit aus dem Schrifttum gewonnenen Daten, lassen darauf schlie?en, da? die Silberkornkrankheit h?ufiger ist als bisher angenommen und in der Tat eine eigenst?ndige neurodegenerative Erkrankung darstellt, die es von der Alzheimer-Erkrankung abzugrenzen gilt.      

Validation du CHIP (questionnaire de coping) dans une population française atteinte de maladies neurologiques

Introduction

While conceived in the 1960's by Lazarus, the concept of coping was a long time coming in the field of neurological diseases. So far, no valid instrument has been available in French for assessing the style of coping of patients with neurological diseases.

Methods

We used Coping with Health Injuries and Problems (CHIP), which was conceived for patients with chronic diseases. We proceeded to a factorial analysis in a population of 307 patients with multiple sclerosis (MS) or Parkinson's disease (PD) in order to identify the factors observed in this population.

Results

We finally retained a model with six factors, which saturated on 24 items and explained 48% of the total variance. Factors we found included palliative coping and distraction, both known for the original instrument, and four new factors: emotional regulation, seeking of well-being/self-preservation, seeking of information and cognitive avoidance.

Discussion

Tools for assessing coping in a setting of chronic diseases must be adapted to specific diseases. In this new validation, CHIP appeared to be well adapted to the specific features of neurological disorders. This instrument would be useful for the neurologist to better understand the specific ways by which patients cope with their disease. Such knowledge would certainly have a positive effect on the patient-neurologist relationship. Moreover, a better understanding of patients’ coping strategies in neurological diseases could pave the way for specific preventive interventions focusing on using coping strategies to promote better adaptation.     

Agreement between multi-detector-row CT angiography and US-ECD in quantification of carotid artery stenosis and plaque characterization

Purpose

The purpose of this work was to evaluate the agreement between ultra-sound echo-color Doppler (US-ECD) and multi-detector-row CT angiography (MDCTA) in the quantification of carotid artery stenosis as well as plaque characterization.

Materials and methods

From January 2012 to January 2013 forty-five patients who underwent both MDCTA and US-ECD for the study of carotid arteries, were evaluated (33 males, 12 females; age range 43–70 years; mean age of 59.6 years). For all subjects the following parameters were analyzed: stenosis degree by using the NASCET method, plaque morphology (regular versus irregular), type of the plaque (fatty, mixed and calcified) and presence of ulcerations. Statistical analysis was performed to calculate concordance between the two techniques employed.

Results

The agreement observed in the quantification of carotid artery stenosis was 94.4% with a kappa value of 0.9306 (95% confidence interval of 0.8612–1.0). In the definition of the type of plaque, the observed agreements were 91.1% and the kappa value was 0.8815 (95% confidence interval: 0.7920–0.9709). In the definition of plaque ulceration, the observed agreements were 88.4% but the kappa value was only 0.325 (95% confidence interval: 0.201–0.449). Agreement observed in the evaluation of plaque morphology was 78.3% with a kappa value of 0.513 (95% confidence interval: 0.452–0.574).

Conclusion

We observed a good agreement between US-ECD and MDCTA in the quantification of carotid artery stenosis and the assessment of plaque type. There was, however, a poor agreement in the evaluation of plaque ulceration. The use of US-ECD and MDCTA provides different results in the evaluation of plaque. Our results suggest that information derived from US-ECD should be always critically compared with other diagnostic techniques.