胶原血管病合并肺间质纤维化35例临床分析

回顾性分析我院35例胶原血管病(CVD)合并肺间质纤维化(PF)患者的临床资料。该组患者除有CVD病史或CVD相应特征外,突出的临床症状是胸闷、气短、咳嗽、咳痰,最常见的肺部体征为吸气末“Velcro”性捻发音。胸片/胸部HRCT显示以双下肺野弥漫网结节影改变为主,部分患者可见胸膜增厚。肺功能改变以限制性通气功能障碍和弥散障碍为特征,血气分析提示低氧血症或轻度过度通气。类风湿性关节炎、进行性系统性硬皮病和干燥综合征合并肺间质纤维化的患者最多,大多数病人的临床表现、肺功能、X线胸片和胸部CT均类似于特发性肺间质纤维化,应注意两者的鉴别。     

Fifteen-year follow-up of 92 hospitalized adults with Down's syndrome: incidence of cognitive decline, its relationship to age and neuropathology

Background The clinical and neuropathological features associated with dementia in Down’s syndrome (DS) are not well established. Aims To examine clinico‐pathological correlations and the incidence of cognitive decline in a cohort of adults with DS. Method A total of 92 hospitalized persons with DS were followed up from 1985 to December 2000. At outset, 87 participants were dementia‐free, with a median age of 38 years. Assessments included the Prudhoe Cognitive Function Test (PCFT) and the Adaptive Behavior Scale (ABS), to measure cognitive and behavioural deterioration. Dementia was diagnosed from case records and caregivers’ reports. Results Eighteen (21%) patients developed dementia during follow‐up, with a median age of onset 55.5 years (range 45–74). The PCFT demonstrated cognitive decline among those with a less severe intellectual disability (mild and moderate) but not among the profoundly disabled people (severe and profound). Clinical dementia was associated with neuropathological features of Alzheimer’s disease, and correlated with neocortical neurofibrillary tangle densities. At the age of 60 years and above, a little more than 50% of patients still alive had clinical evidence of dementia. Conclusions Clinical dementia associated with measurable cognitive and functional decline is frequent in people with DS after middle age, and can be readily diagnosed among less severely intellectually disabled persons using measures of cognitive function such as the PCFT and behavioural scales such as the ABS. In the more profoundly disabled people, the diagnosis of dementia is facilitated by the use of behavioural and neurological criteria. In this study, the largest prospective DS series including neuropathology on deceased patients, the density of neurofibrillary tangles related more closely to the dementia of DS than senile plaques. In people with DS surviving to middle and old age, the development of dementia of Alzheimer type is frequent but not inevitable, and some people with DS reach old age without clinical features of dementia.     

肾细胞癌中血管内皮生长因子的表达

目的 探讨肾癌组织中血管内皮生长因子的表达及其与肾癌生物学行为的关系。方法 应用单克隆鼠抗-VEGF抗体通过免疫组化SP法研究肾癌中血管内皮生长因子的表达。结果 60例肾癌组织中35例(58.3％)血管内皮生长因子阳性。血表达与组织学分级(P<0.05)和TNM分期(P<0.05)均明显相关。 结论 血管内皮生长因子表达对肾癌生物学行为有重要影响,设法抑制血管内皮生长因子有望成为肾癌治疗的另一有效方法。     

Brain tissue microarrays in dementia research: White matter microvascular pathology in Alzheimer's disease

Tissue microarrays (TMA) consist of up to 1000 cylindrical tissue cores from different donor paraffin blocks relocated into one recipient block, allowing for efficient histopathological studies by fluorescence in situ hybridization, RNA in situ hybridization or immunohistochemistry. On the background of the increasing interest of the TMA technique in cancer research and the suggestion of its application also in studies of non‐neoplastic intracranial disorders, the technique was applied to pathologic white matter in AD brains. Eight cases with AD and concomitant white matter pathology were neuropathologically diagnosed on whole brain coronal slides. The TMA technique was used to grade severity of white matter pathology and to quantify small vessels with traditional staining and immunohistochemical markers. These measurements were compared with the whole brain neuropathological assessment. The technique produced good results with preserved tissue structures as confirmed by the whole brain evaluation. Severity of white matter pathology evaluated on the TMA cores correlated negatively with small vessel quantities, and statistically significant differences in vessel quantities paralleled different grades of white matter pathology. It is concluded that the TMA technique could be further utilized in studies of dementing disorders, and may have its advantages in large, clinically well‐characterized materials (e.g. in quantitative mapping of white matter changes).     

钾通道开放剂降低血管平滑肌细胞内游离钙浓度(英文)

目的:研究PCO—Pin,Nic,Lem及RP对VMSC内[Ca~(2 )]_i的改变及其可能机制。方法:VSMC加入Fura-2 AM 2.5μmol·L~(-1)37℃下孵育50min,[Ca~(2 )]_i用荧光分光光度计检测。结果:4种PCO能较弱地抑制K~ 30 mmol·L~(-1)诱导的[Ca~(2 )]_i增加,但明显抑制ATP 0.1mmol·L~(-1)诱导的[Ca~(2 )]_i峰相及持续相增加,且呈剂量依赖性。格列苯脲完全阻断Pin,Lem及RP的作用,只部分抑制Nic的作用。无钙液中先给4种PCO,能显著抑制ATP诱导的[Ca~(2 )]_i峰相增加。结论:4种PCO均抑制ATP诱导的[Ca~(2 )]_i增加,此作用与减少细胞外钙内流及细胞内钙释放有关。     

CT增强扫描在评价NSCLC血管生成中的临床意义

目的　探讨非小细胞肺癌 (NSCLC)血管内皮生长因子 (VEGF)的表达水平与CT增强程度的关系 ,从影像学角度评价肿瘤血管生成在肺癌诊断、治疗及淋巴结转移中的临床价值。方法　对 30例NSCLC病人进行动态螺旋CT扫描 (SCT) ,测量病灶增强幅度 ,并利用免疫组化技术检测VEGF。对病灶增强值、VEGF阳性表达及淋巴结转移情况进行统计学分析。结果　 30例肺癌病人CT增强值均数为 (36 .2 8± 6 .41 )HU ,VEGF阳性表达 2 1例 ,阴性表达 9例。VEGF在中晚期的阳性表达高于早期病人 (Ρ<0 .0 5) ,淋巴结转移组高于非淋巴结转移组 (Ρ <0 .0 5) ;癌灶增强值与VEGF阳性表达、肿瘤分期及淋巴结转移亦呈正相关。结论　NSCLC的CT增强程度能够反映肿瘤的血管生成 ,并与淋巴结转移密切相关 ,有助于肺癌的诊断、TNM分期 ,而且可以从肿瘤分子生物学行为方面补充目前肺癌分期方法的不足     

Mechanisms of pinacidil-induced vasodilatation

The mechanism of the vasodilator effect of pinacidil was examined. Pinacidil (0.1–100 μM) inhibited the increases in cytosolic Ca²⁺ ([Ca²⁺]_i) and muscle tension due to norepinephrine in rat aorta. In contrast, a Ca²⁺ channel blocker, verapamil, inhibited the norepinephrine-stimulated [Ca²⁺]_i more strongly than the contraction. Higher concentrations of pinacidil (3–100 μM) inhibited the verapamil-insensitive portion of the contraction and [Ca²⁺]_i. An inhibitor of ATP-sensitive K⁺ channels, glibenclamide, antagonized the inhibitory effect of low concentrations ( 10 pM) of pinacidol. Pinacidil did not change the contraction induced by Ca²⁺ in vascular smooth muscle permeabilized with Staphylococcus aureus -toxin. Norepinephrine (in the presence of GTP), 12-deoxyphorbol 13-isobutyrate (in the absence of GTP), and treatment with GTP_γS potentiated the contraction of permeabilized smooth muscle induced by the addition of Ca²⁺. Pinacidil (100 μM) inhibited the potentiation due to GTP_γS or noepinephrine but not to phorbol ester. These results suggest that pinacidil has dual effects on vascular smooth muscle contraction. At lower concentrations (>0.1 μM), it decreases [Ca²⁺]_i, possibly by activating ATP-sensitive K+ channels. At higher concentrations (> 3 μM), it may additionally inhibit the receptor-mediated, GTP-binding protein-coupled phosphatidyl inositol turnover.     

The natural history of dementia in ageing people with intellectual disability

In a retrospective follow-up study over 11 years, the incidence and natural history of dementia was assessed in an institutionalized group of 144 people, aged 60 years and over, with mild to profound intellectual disability resulting from causes other than Down's syndrome. Age-related incidences, age at onset, duration and symptoms of dementia were comparable to those in the general population. The frequent and invalidating physical comorbidity (11 /11) hampered the diagnostic process in this group. The high prevalence of episodes of delirium (9/11) and depressive symptoms (8/11) as the first manifestations of dementia and/or during dementia might reflect increased vulnerability as compared to other ageing people.     

Going, going, gone . . . ? Implicit and explicit tests of conceptual knowledge in a longitudinal study of semantic dementia

Patients suffering from semantic dementia provide important constraints on theories of the structure and organisation of semantic memory. In this article we report one such patient, AM, whose progressive deterioration of semantics enables us to address the much-debated issue of whether conceptual structure is hierarchically organised. The hierarchical account predicts that brain damage should impair lower levels of the hierarchy (property information) before affecting higher level (category) information (Warrington and Shallice, Q. J. Exp. Psychol. 1975, 27, 635–657). We evaluate this prediction by repeated testing of AM in two studies—a semantic priming task and a verification task—over an 18 month period, contrasting the progressive deterioration of properties (functional and perceptual) and category relations (category co-ordinates and category labels). Properties were preserved longer than category information, arguing against a hierarchical account of semantic memory. In addition, functional properties were most robust to brain damage, supporting our claim that functional information plays a special role in semantic representations (Durrant-Peatfield et al., Proc. 19th Ann. Conf. of the Cognitive Science Society. Erlbaum, Mahwah, NJ, 1997, pp. 193–198. Tyler et al., Cognitive Neuropsychol. 1997, 14, 511–545).     

Approved indications of lipo-PGE1 in Japan

For its peripheral vascular dilating effect and platelet agglutination inhibitory activity, prostaglandin E₁ is used in the treatment of diseases which are likely to cause peripheral circulatory failure or thrombus. In Japan, lipo-PGE₁, which was developed to give it a target-directed nature by modifying the conventional PGE₁, has been used and found to be useful in clinical practice. In this report, we attempt to describe the clinical benefits of lipo-PGE₁ focusing on the diseases which have been approved for its indications.