绝经后2型糖尿病患者性激素结合球蛋白与动脉粥样硬化危险因子的相关性

目的研究绝经后2型糖尿病（T2DM）患者的性激素结合球蛋白（SHBG）与动脉粥样硬化（AS）危险因子的相关性。方法绝经后T2DM患者45例（20例合并大血管并发症,25例无大血管并发症）,测定SHBG、FPG、Fins、FC—P、TC、TG、HDL—C、LDL-C、纤维蛋白原（FIB）。以ISI=-Ln（FPG·Fins）作为胰岛素敏感性指标。对SHBG与BMI、WHR、FPG、Fins、FC—P、ISI、脂代谢指标、FIB的相关性进行分析。结果有大血管并发症组SHBG、ISI显著低于无大血管并发症组,而WHR、FPG、Fins、FC-P、TC、LDLC、FIB显著高于无大血管并发症组。在简单相关分析中,SHBG与ISI呈显著正相关（R=0．731,P〈0．01）。在逐步叫归分析中,FC-P为预测SHBG最强的指标。结论低水平的SHBG是绝经后2型糖尿病患者动脉粥样硬化的危险因素之一。     

Epilepsy related to hypothalamic hamartomas: surgical management with special reference to gamma knife surgery

Objective

A large spectrum of surgical techniques can be proposed to young patients presenting with hypothalamic hamartomas (HH) associated with severe epilepsy. The aim of this report is to point on some clinical and anatomical parameters supposed to influence the choice of the surgical approach and to emphasize the specific role of radiosurgery.

Materials and methods

We reviewed both our experience and the recent literature based on a Pubmed search. Lateral pterional, midline frontal through the lamina terminalis, transcallosal interforniceal approaches, endoscopic treatment through the foramen of Monro, disconnecting surgery, radiofrequency ablation, brachytherapy and gamma knife surgery (GKS) were all considered. Mortality, morbidity, and efficacy of each of these techniques were compared. Specific limits, difficulties, and constraints were taken into account. Our experience of radiosurgery is based on a prospective trial which enrolled 60 patients with HH and associated severe epilepsy between October 1999 and December 2005.

Results

Several surgical techniques can lead to a real reversal of the epileptic encephalopathy. The main factors for the decision-making process are the age, the size of the lesion and its anatomical type (according to our original classification), the severity of the epilepsy, and the severity of the cognitive/psychiatric comorbidity. In our prospective trial (GKS), 27 patients have a follow-up superior to 3 years. Among those, 59.2% have an excellent result with a dramatic behavioral and cognitive improvement and are completely seizure-free (37%) or have only rare non-disabling seizures (22.2%). No permanent neurological complication has been observed so far; three patients have presented a transient poïkilothermia. GKS is clearly the safer approach for these difficult patients. Young patients with severe epilepsy and comorbidity must be operated on using a curative approach as early as possible. Very large type VI or mixed type with a large component above the floor of the third ventricle must be disconnected and then the upper remnant can be ideally treated by GKS (staged surgery). Type V (rarely epileptic) and IV are frequently operable by disconnection. Type I HH deeply embedded in the hypothalamus are operated on by GKS efficiently and safely. Type II HH can be operated on either endoscopically or transcallosally or by GKS depending on the parents’ choice and severity of epilepsy. In small type III HH, GKS is a safer procedure, due to the very close relationship to the fornix and mammillary bodies. In very large type III HH, transcallosal interforniceal approach is proposed but with significant risks especially concerning short-term memory. When the lesion is sufficiently small, GKS is globally offering the patient a rate of seizure cessation comparable to microsurgery with, however, a much lower risk (no neurological deficit reported till now).

Conclusion

Our first results indicate that GKS is as effective as microsurgical resection and very much safer. GKS also allows avoiding the vascular risk related to radiofrequency lesioning or stimulation. The disadvantage of radiosurgery is its delayed action. Longer follow-up is mandatory for a reliable evaluation of the role of GKS. The early effect on subclinical discharges turns out to play a major role in the dramatic improvement of sleep quality, behavior, and developmental learning acceleration at school.     

退白汤对小鼠免疫功能的调节作用

目的:探讨退白汤对小鼠免疫功能的影响。方法:C57BL/6 J雌性小鼠随机分组,分别灌胃退白汤低、中、高剂量分别为:14.15g生药/kg、28.30g生药/kg、56.60g生药/kg;白癜风胶囊剂量为0.60g/kg;正常对照组给予等容量生理盐水灌胃。给药7d后检测退白汤对小鼠脾脏和胸腺的重量、腹腔巨噬细胞吞噬功能、血清免疫球蛋白IgG、IgA、IgM含量、血清IL-2、TFN-α含量以及对迟发型超敏反应的影响。结果:退白汤低、中、高剂量均可明显抑制小鼠脾、胸腺指数和小鼠腹腔巨噬细胞的吞噬功能,显著降低小鼠血清IgG、IgA、IgM活性,降低IL-2和TFN-α含量,并抑制迟发型超敏反应。以上各项指标中,退白汤起效剂量为14.15g生药/kg,最高用药剂量为56.60g生药/kg,各用药组与对照组比较均具有显著性差异,并呈现良好的量效依赖关系。结论:退白汤可抑制小鼠免疫功能。     

肢端肥大症患者79例临床治疗分析

目的探讨使用长效生长抑素类似物结合神经外科切除或伽玛刀治疗后激素变化和影像学复查来评价肢端肥大症患者治疗疗效。方法肢端肥大症患者79例,其中男性51例,女性28例,分为长效生长抑素（兰瑞肽lanreotide^TM）结合神经外科切除治疗（A组）和长效生长抑素（兰瑞肽lanreotide^TM）结合伽玛刀治疗组（B组）,所有患者均给予肌注长效生长抑素,在药物使用结束4w后对患者进行临床评估并施行经蝶窦手术切除肿瘤或者接受伽玛刀治疗。随访瘤体体积变化及内分泌水平变化。结果多数患者的临床症状得到显著改善。与垂体微腺瘤组相比,药物治疗对垂体大腺瘤组体积缩小有更明显的作用。手术组微腺瘤组明显优于大腺瘤组;放射外科组结果：肿瘤缩小概率随随访时间的延长会明显提高,而且随着随访时间的延长,生长激素（GH）和胰岛素生长因子（IGF-Ⅰ）值降至正常的概率明显提高。结论生长抑素类似物（兰瑞肽lanreotide^TM）结合神经外科切除或伽玛刀治疗肢端肥大症患者可以获得较好的临床疗效,远期疗效有待于进一步观察。     

伽玛刀照射后猫脑运动区皮质GFAP、S-100蛋白变化的研究

目的研究伽玛刀照射猫脑额叶运动区皮质后该区星形胶质细胞(Astrocyte,AST)中胶质原纤维酸性蛋白(Glial fibrillary acidic protein,GFAP)和S-100蛋白表达的变化,为临床上伽玛刀治疗癫痫等疾病选择合适剂量,减少不良反应,提供敏感监测指标。方法健康家猫45只,随机分为对照组、伽玛刀10Gy和25Gy组,于照射后24小时、7天、14天,对靶区取材,进行GFAP、S-100检测。结果伽玛刀照射猫额叶运动区皮质后14天内GFAP和S-100蛋白均有表达增强,与照射剂量和时间正相关。结论伽玛刀照射猫额叶运动区皮质后14天内GFAP和S-100蛋白均有表达增强,与剂量和时间成正相关。S-100蛋白可能是放射性脑损伤急性期更敏感的指标。     

Radiosurgical Considerations in the Treatment of Large Cerebral Arteriovenous Malformations

Objective

In order to establish the role of Gamma Knife radiosurgery (GKS) in large intracranial arteriovenous malformations (AVMs), we analyzed clinical characteristics, radiological features, and radiosurgical outcomes.

Methods

Between March 1992 and March 2005, 28 of 33 patients with large AVMs (> 10 cm³ in nidus-volume) who were treated with GKS underwent single session radiosurgery (RS), and the other 5 patients underwent staged volumetric RS. Retrospectively collected data were available in 23 cases. We analyzed treatment outcomes in each subdivided groups and according to the AVM sizes. We compared the estimated volume, defined as primarily estimated nidus volume using MR images, with real target volume after excluding draining veins and feeding arteries embedded into the nidus.

Results

Regarding those patients who underwent single session RS, 44.4% (8/18) had complete obliteration; regarding staged volumetric RS, the obliteration rate was 40% (2/5). The complete obliteration rate was 60% (6/10) in the smaller nidus group (10-15 cm³ size), and 25% (2/8) in the larger nidus group (over 15 cm³ size). One case of cerebral edema and two cases (8.7%) of hemorrhage were seen during the latent period. The mean real target volume for 18 single sessions of RS was 17.1 cm³ (10.1-38.4 cm³), in contrast with the mean estimated volume of 20.9 cm³ (12.0-45.0 cm³).

Conclusion

The radiosurgical treatment outcomes of large AVMs are generally poor. However, we presume that the recent development in planning software and imaging devices aid more accurate measurement of the nidus volume, therefore improving the treatment outcome.     

Effects of Low Frequency Repetitive Transcranial Magnetic Stimulation (rTMS) on Gamma Frequency Oscillations and Event-Related Potentials During Processing of Illusory Figures in Autism

Previous studies by our group suggest that the neuropathology of autism is characterized by a disturbance of cortical modularity. In this model a decrease in the peripheral neuropil space of affected minicolumns provides for an inhibitory deficit and a readjustment in their signal to noise bias during information processing. In this study we proposed using low frequency transcranial magnetic stimulation (rTMS) as a way increasing the surround inhibition of minicolumns in autism. Thirteen patients (ADOS and ADI-R diagnized) and equal number of controls participated in the study. Repetitive TMS was delivered at 0.5 Hz, 2 times per week for 3 weeks. Outcome measures based on event-related potentials (ERP), induced gamma activity, and behavioral measures showed significant post-TMS improvement. The results suggest that rTMS offers a potential therapeutic intervention for autism.     

肾移植受者预防性应用兔抗人胸腺细胞免疫球蛋白的有效性和安全性

目的 探讨肾移植受者预防性应用兔抗人胸腺细胞免疫球蛋白(ATG-R)的有效性和安全性.方法 选择2003年5月至2006年12月期间的肾移植受者655例,分为试验组(84例)和对照组(571例).两组受者在年龄、性别、群体反应抗体(PRA)、HLA配型、常规免疫抑制剂的应用等方面比较,差异无统计学意义.对试验组受者采取术前1次较大剂量(1.5 mg/kg)和术后短时间小剂量(0.5～1 mg/kg)预防性应用ATG-R;对照组受者仅采用常规免疫抑制方案.分析和比较两组受者术后移植物功能延迟恢复(DGF)发生率、术后6个月内急性排斥反应(AR)发生率、术后6个月内感染发生率及人/肾1年存活率等指标.结果 试验组和对照组DGF发生率分别为2.38%和8.40%,试验组明显低于对照组,差异有统计学意义(P＜0.01);术后6个月内AR发生率分别为4.76%和11.03%,试验组低于对照组,差异有统计学意义(P＜0.05);试验组和对照组术后6个月内感染发生率分别为10.71%和9.81%,两组比较,差异无统计学意义(P＞0.05).两组的人/肾1年存活率比较,差异也无统计学意义(P＞0.05).结论 肾移植受者预防性应用ATG-R能够明显降低DGF和AR发生率,且不增加感染发生率,是一种有效和安全的免疫诱导措施.