Health‐related quality of life in multiple system atrophy

Although multiple system atrophy (MSA) is a neurodegenerative disorder leading to progressive disability and decreased life expectancy, little is known about patients' own evaluation of their illness and factors associated with poor health‐related quality of life (Hr‐QoL). We, therefore, assessed Hr‐QoL and its determinants in MSA. The following scales were applied to 115 patients in the European MSA‐Study Group (EMSA‐SG) Natural History Study: Medical Outcome Study Short Form (SF‐36), EQ‐5D, Beck Depression Inventory (BDI), Mini‐Mental state examination (MMSE), Unified MSA Rating Scale (UMSARS), Hoehn & Yahr (H&Y) Parkinson's disease staging scale, Composite Autonomic Symptom Scale (COMPASS), and Parkinson's Disease Sleep Scale (PDSS). Forty‐six percent of patients had moderate to severe depression (BDI ≥ 17); Hr‐QoL scores on the SF‐36 and EQ‐5D were significantly impaired. Pain, the only domain with similar scores in MSA and published PD patients, was reported more frequently in patients with MSA‐P (predominantly parkinsonian motor subtype) than MSA‐C (predominantly cerebellar motor subtype; 76% vs. 50%; P = 0.005). Hr‐QoL scores correlated most strongly with UMSARS motor, COMPASS, and BDI scores but not with MMSE scores, age at onset, or disease duration. The COMPASS and UMSARS activities of daily living scores were moderate‐to‐strong predictors for the SF‐36 physical summary score and the BDI and UMSARS motor scores for the SF‐36 mental summary score. This report is the first study to show that Hr‐QoL is significantly impaired in MSA. Although not all possible factors related to impaired Hr‐QoL in MSA could be assessed, autonomic dysfunction, motor impairment, and depression were most closely associated with poor Hr‐QoL, and therapeutic management, therefore, should concentrate upon these aspects of the disease. © 2006 Movement Disorder Society     

老龄大鼠非细菌性多器官功能不全综合征模型的建立

目的以酵母多糖腹腔注射建立老龄大鼠多器官功能不全综合征(MODSE)模型,并进一步与成年多器官功能不全综合征(MODS)模型作比较.方法成年和老龄SD大鼠,腹腔注射不同剂量酵母多糖,以血气、血生化和心、肝、脑、肺、肾等各主要脏器的光镜检查等为指标,观察上述各主要脏器的功能和形态学的变化.结果与成年和老龄正常对照组相比,成年和老龄不同酵母多糖组血气和血生化指标均出现不同程度的改变,肺、心、肝、脑、肾等主要脏器出现明显病理改变.在相同酵母多糖浓度下,老龄组呼吸功能、心脏功能和肾脏功能降低较相应成年组重;在复制模型程度相似的情况下,与成年大鼠相比,老龄大鼠有死亡时间延迟的趋势.结论酵母多糖腹腔注射可复制MODSE模型,以0.5 g/kg腹腔注射最为理想,该模型可用于MODSE机制和实验治疗学的探讨.     

创伤性膈疝并发多器官功能障碍的诊治

目的　探讨急性创伤性膈疝的发病机理 ,临床特征和处理方式。方法　回顾性分析2 6例急性创伤性膈疝的临床资料。结果　患者均为多发伤 ,有不同程度的呼吸困难 ,均行手术探查 ,膈肌修补。 2例术中死亡。 14例术后出现多器官功能障碍 ,其中 3例术后死于多器官衰竭。本组 2 1例存活。结论　外伤性膈疝早期诊断 ,及时手术 ,防治并发症可提高抢救成功率。     

肾癌多中心病灶发生机理的探讨

目的　探讨肾癌多中心病灶的发生机理。　方法　肾癌根治术标本 10 2例 ,间隔 3mm切开检查切面 ,原发灶外可疑处取材证实肾癌者为多中心灶阳性。免疫组化法检查肾癌原发灶及多中心灶p5 3、PCNA、c erbB2 、CD44 v6、bcl 2、nm2 3 H1 蛋白表达情况。　结果　多中心灶发生率为 15 .7%( 16 10 2 ) ,16例多中心性肾癌中 ,原发灶与多中心灶p5 3、PCNA、c erbB2 、CD44 v6、bcl 2、nm2 3 H1 蛋白表达情况均相近 ,统计学处理差异无显著性意义 (P均 >0 .4)。　结论　肾癌多中心灶具有与原发灶相似的生物学特征 ,其发生以原发灶肾内转移可能性大。     

努力提高严重多发伤的基础研究和临床救治水平

目的:探讨提高严重多发伤的基础研究和临床救治水平。方法:结合我们的有关研究和参加抢救的临床救治体会,并引用国内外公开发表的相关论文及著作进行分析研究。结果:善于应用现有的先进科技手段,提高严重多发伤的基础研究和临床救治水平。降低伤残率和死亡率。结论:严重多发伤具有脏器损伤率高、出血性休克率高、感染率高、MODS发生率高、死亡率高等“五高”特点,所以其诊治的复杂性、紧迫性远远超过其他许多疾病。因此努力提高我国严重多发伤的基础研究及诊断和救治水平已是当务之急。     

CXCL10 haplotypes and multiple sclerosis: association and correlation with clinical course

CXCL10 (interferon- γ -inducible protein-10) levels are increased in cerebrospinal fluid of multiple sclerosis (MS) patients with symptomatic attacks of inflammatory demyelination, supporting a role for this molecule in MS pathogenesis. Two hundred and twenty-six patients with MS and 235 controls were genotyped for G  →  C and T  →  C single nucleotide polymorphisms (SNPs) in exon 4 of CXCL10 gene. Haplotypes were tested for association and correlated with clinical variables. The two SNPs studied were in complete linkage disequilibrium. None of the determined haplotypes was associated with MS. However, carriers of the GGTT haplotype (defined as wild type, according to the sequence in National Centre for Biotechnology Information (NCBI) database) had a significantly lower progression index than non-carriers ( P  = 0.016). Furthermore, amongst patients who had an initial relapsing remitting (RR) course of the disease, the time between onset and second episode was significantly longer in GGTT carriers ( P  = 0.021). Considering secondary progressive (SP)–MS patients, the time between the initial RR form and the subsequent worsening to SP was longer in this group ( P  = 0.08). Therefore, the GGTT haplotype of the CXCL10 gene is not a susceptibility factor for the development of MS, but is probably to influence the course of MS, possibly contributing to slow down the progression of the disease.     

金属蛋白酶2、血管内皮生长因子和肿瘤抑制因子在人脑胶质瘤中的表达和临床意义

目的:探讨人脑胶质瘤中的金属蛋白酶2(MMP-2)、血管内皮生长因子(VEGF)和肿瘤抑制因子(P16)的表达。方法:应用免疫组化法检测55例胶质瘤组织中的MMP-2、VEGF和P16蛋白的表达,通过原位杂交检测MMP-2 mRNA的表达。结果:胶质瘤的恶性程度与MMP-2、VEGF表达和P16的缺失表达呈正相关,随着胶质瘤的恶性程度的增高而增加。结论:胶质瘤的恶性程度由多种因素决定。胶质瘤中MMP-2含量越高,肿瘤细胞在浸润的过程中突破血脑屏障的能力越强;VEGF的表达增加,肿瘤的血液供应越丰富,恶性程度越高。P16蛋白缺失率高,组织学分化程度低,在一定程度上反映了胶质瘤细胞的恶性生物学行为。     

自体外周血纯化CD34+细胞移植治疗进展型多发性硬化

目的 评价自体外周血纯化CD34+细胞移植治疗进展型多发性硬化(PMS)的安全性和疗效.方法 2002-09―2006-03期间15例PMS患者在首都医科大学宣武医院接受了自体外周血纯化CD34+细胞移植.单独使用粒细胞集落刺激因子(G-CSF)动员造血干细胞,全部回输采集物进行CD34+细胞纯化.预处理采用BEAM(卡氮芥、依托泊甙、阿糖胞苷、马法兰)方案.中位随访期为21(3～45)个月,移植前后应用扩充神经功能残疾量表(EDSS)、年平均发病次数进行疗效评价. 结果分选后中位CD34+细胞纯度为93.2 (78.6～97.7)%,中位回收率为67.0(22.4～79.8)%,相当于减少了4个对数级的T细胞.无移植相关死亡,造血重建时间与其自体外周造血干细胞移植(APBSCT)相当,未出现严重的毒性反应及并发症.患者移植后12个月EDSS评分(3.95±2.55)较移植前(5.64±0.71)降低(P＜0.05),年平均发病次数移植后(0.45±0.82)较移植前(1.31±0.71)减少(P＜0.05).移植后45个月疾病无活动者生存率为(47.01±17.87)%,EDSS评分无进展者(包括稳定和改善)生存率为(57.69±20.24)%. 结论自体外周血纯化CD34+细胞移植治疗PMS安全有效.     

复合维生素E,C,B组合物面膜治疗寻常痤疮117例的疗效和安全性(英文)

目的:了解维生素E,C,B组合物面膜治疗寻常痤疮的疗效及安全性。方法:117例13a以上、痤疮严重程度分级在2级以上且主要表现于脸部的病人,予维生素E,C,B组合物面膜治疗,每日1次,共8wk。观察治疗前后痤疮数量及性质,包括粉刺、丘疹、脓疱及囊肿之数目,并评估整体疗效。结果:治疗后,粉刺、丘疹、脓疱及囊肿数目下降了13±s13,10±12,5±7及3±3,均P<0.01。7例(6.0%)病人症状完全改善,44例(37.6%)中度改善,56例(47.9%)轻度改善,10例(8.6%)无改善。59例(50.4%)病人无红肿、搔痒、灼热及脱皮等现象发生。结论:维生素E,C,B组合物面膜治疗痤疮有效,超过半数的受试者无不良反应发生,可作为传统治疗寻常痤疮药物的替代。