Dysphagia in Parkinson's disease: Pharyngeal manometry and fiberoptic endoscopic evaluation

ObjectiveDysphagia is a common symptom in Parkinson's disease (PD) and it represents a negative prognostic factor because of its complications. This study is to evaluate pharyngeal dysphagia for boluses of various consistencies with Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and Pharyngeal High-Resolution Manometry (PHRM) in a group of PD patients, making a comparison between the information provided by the two exams.MethodsGroup of 20 patients affected by PD was selected and initially subjected to a qualitative evaluation of the swallowing performing FEES. Subsequently, they were evaluated by PHRM to identify quantitative measures associated with pressures expressed by pharyngeal organs during swallowing. Values obtained in the study group were compared with those recorded in a group of 20 healthy subjects.ResultsStudy showed that Pmax (the maximum pressure elicited by the single pharyngeal muscle structures involved in swallowing) was significantly lower than the control group (p<0.05) for all the boluses and consistency tested, in particular for the Tongue base and the Cricopharyngeal muscle. Pmean pre-swallowing pressure (represents the mean value of a contraction in which basal and maximal pressure where normally calculated) was significantly higher compared to normal subjects for the Tongue base and the Cricopharyngeal muscle (p<0.05). Mean intra-swallowing pressure was higher for the Velopharynx and the Cricopharyngeal muscle, but lower for the tongue base. Pmax and Pmean at PHRM were altered independently to the degree of dysphagia detected at FEES, and they did not correlate either with the location of the residue or with the type of bolus. Images displayed at the FEES, found the corresponding biomechanical explanations in the PHRM, which also allowed us to quantify the extent of the dysfunction, through the calculation of the pressures generated in the various structures studied.ConclusionPHRM is particularly useful in the early detection of dysphagia, when FEES may still show no evidence of abnormal swallowing.     

慢性前列腺炎合并前列腺结石的临床研究

目的 探讨慢性前列腺炎(CP)与前列腺结石(PC)的关系.方法 对500例健康人群和491例CP患者经直肠B超检测PC,将其分成CP与CP+Pc组,进行CPSI评分.结果 ①对照组PC的检出率随年龄增大而增高(χ2=68,P<0.001);②CP与对照组各年龄段PC的检出率差异有显著性(P<0.001);CP组各年龄段PC的检出率分别为15.79%、30.09%、55.66%、66.15%、82.76%,各年龄段间差异有显著性(P<0.001);③CP与CP+PC组CPSI评分差异无显著性(P>0.05).结论 CP中PC的检出率明显增多,且随年龄增大而增高;年龄与CP是形成PC的重要因素.     

多巴胺对鱼藤酮诱导α-突触核蛋白聚集的促进作用

目的:探讨多巴胺能细胞内多巴胺在鱼藤酮诱导α-突触核蛋白聚集过程中的作用。方法:采用鱼藤酮(1μmol/L)处理PC12细胞,流式细胞术检测双氢罗丹明123荧光强度;Western印迹法检测胞质内α-突触核蛋白表达;免疫荧光法观察α-突触核蛋白聚集体。并采用多巴胺耗竭剂——利血平预处理3h,观察上述指标。结果:鱼藤酮处理24h后,PC12细胞内过氧化物水平显著升高,而利血平(1μmol/L和5μmol/L)预处理后,细胞内过氧化物水平较鱼藤酮组显著下降(P<0.05)。鱼藤酮处理后,α-突触核蛋白表达水平显著升高,胞质内可见α-突触核蛋白免疫阳性的聚集体形成;采用利血平预处理后,α-突触核蛋白表达水平较鱼藤酮组显著下降(P<0.05),α-突触核蛋白聚集体面积减小。结论:在鱼藤酮作用过程中,多巴胺可促进α-突触核蛋白表达上调及其聚集体的形成。     

对羊水栓塞的再认识

羊水栓塞是严重而罕见的产科并发症,其发病机制至今尚未阐明。一直以来,诊断羊水栓塞的金标准是在母体中心静脉血或肺动脉血管床组织切片中找到胎儿的有形成分,但目前的研究已使羊水栓塞的诊断受到质疑,母血中找到胎儿有形成分不再是诊断的必须依据。对于羊水栓塞的诊断,国内强调的是发病机制和病理过程,国外强调的是临床表现。目前认为羊水栓塞的发生无法通过对高危因素的识别和干预进行预测和预防。发生羊水栓塞后的抢救重点主要是支持和对症治疗。     

内毒素诱导新生大鼠肺损伤及地塞米松的保护作用

目的 腹腔注射内毒素（lipopolysaccharide，LPS）致新生大鼠急性肺损伤（acute lung injury，ALI），观察ALI不同时期应用地塞米松（dexamethasone，Dex）对肺损伤和TNF-α、IL-10的影响，为临床选择糖皮质激素应用时机提供理论依据。方法 57只健康7日龄Wistar大鼠制备新生大鼠内毒素血症模型，取9只模型鼠腹腔注射LPS（5mg／kg）后光镜下观察有无ALI病理改变。取剩余48只模型鼠随机分为：LPS组（n=16）：模型鼠腹腔注射LPS（5mg／kg）；LPS后1h地塞米松干预组（LPS1h＋Des组）（n=16）：经腹腔注射LPS（5mg／kg）后1h注射Dex（5mg／kg）；LPS后2h地塞米松干预组（LPS2h＋Des）（n=16）：腹腔注射LPS（5mg／kg）后2h注射Dex（5mg／kg）。另外10只非模型鼠作为对照组：经腹腔注射等量的0．9％氯化钠溶液0．1ml。每组均于注射后12h断颈处死，留取部分血液进行血气分析，并测定肺组织TNF-α和IL-10含量，观察肺组织形态改变。结果 地塞米松干预组大鼠病死率低于LPS组，2h组（6．25％）低于1h组（25．0％）；肺组织病理改变LPS2h＋Des组较LPS组有明显改善。实验组pH值、PaO2和PaCO2均低于对照组，差异均有统计学意义（P〈0．05）；与LPS1h＋Dex组[分别为6．88±0．06，（6．61±0．84）kPa和（7．43±0．71）kPa]相比，LPS2h＋Dex组pH值7．23±0．12、PaO2[（7．92±0．75）kPa]升高，而PaCO2[（6．93±0．69）kPa]降低，差异有统计学意义（P〈0．05）。LPS1h＋Dex组TNF-α含量为（14．89±3．36）pg／mg，IL-10含量为（0．20±0．05）pg／mg；LPS2h＋Dex组TNF—α含量降低，为（10．54±3．43）pg／mg；IL-10含量升高，为（0．31±0．07）pg／mg，差异均有统计学意义（P〈0．05）。结论 LPS可诱导新生大鼠肺损伤，导致TNF-α增高，IL-10水平降低，提示新生动物发生ALI／ARDS预后不良；在应用地塞米松治疗时应考虑到新生动物ALI／ARDS病理变化发展进程，适时应用，以免发生免疫功能抑制。     

4月龄以下小婴儿川崎病30例临床分析

目的分析4月龄以下小婴儿川崎病的临床发病特点。 方法对1999-01—2005-12首都儿科研究所附属儿童医院收治的4月龄以下川崎病患儿30例，进行临床资料回顾性分析。 结果4月龄以下小婴儿川崎病以男孩多发，无季节差异；以典型病例多见，但仍有约20%患儿为非典型病例，平均确诊时间长，误诊率较高。 结论冠状动脉异常可作为小婴儿非典型川崎病惟一确诊的金指标。同时对于发热>5ｄ，在感染性疾病恢复期再次高热，有明确病毒或细菌感染 存在，有预防接种后不明原因发热持续不退的4月龄以下小婴儿应警惕川崎病的发生。     

Early identification of the risk for free radical-related diseases in preterm newborns

Background

Despite recent advances in preterm newborns healthcare, perinatal pathologies and disabilities are increasing. Oxidative stress (OS) is determinant for the onset of an unbalance between free radicals (FRs) production and antioxidant systems which plays a key role in pathogenesis of pathologies such as retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), grouped as ‘free radical-related diseases’ (FRD).

Aim

This study tests the hypothesis that OS markers levels in cord blood may predict the onset of FRD pathologies.

Patients and methods

168 preterm newborns of GA: 24-32 weeks (28.09 ± 1.99); and BW: 470-2480 gr (1358.11 ± 454.09) were consecutively recruited. Markers of potential OS risk (non-protein bound iron, NPBI; basal superoxide anion, BSA; under stimulation superoxide anion, USSA) and markers of OS-related damage (total hydroperoxides, TH; advanced oxidation protein products, AOPP) were assessed in cord blood. Associations between FRD onset and OS markers were checked through inferential analysis (univariate logistic regression).

Results

The development of FRD was significantly associated to high cord blood levels of TH, AOPP and NPBI (respectively p = 0.000, OR = 1.025, 95%CI = 1.013-1.038; p = 0.014, OR = 1.092, 95%CI = 1.018-1.172; p = 0.007, OR = 1.26995%CI = 1.066-1.511).

Conclusions

Elevated levels of TH, AOPP and, above all, NPBI, in cord blood are associated with increased risk for FRD. OS markers allow the early identification of infants at risk for FRD because of perinatal oxidant exposure. This can be useful in devising strategies to prevent or ameliorate perinatal outcome.     

重症71型肠道病毒感染的临床特征与治疗12例分析

目的 探讨肠道病毒71型(enterovirus 71,EV71)感染所致重症病例的临床特征、病理生理变化,评估治疗效果.方法 对2008年湖北省9家定点医院收治的EV71感染重症手足口病(hand,foot and mouth disease,HFMD)病例的临床资料进行回顾性分析.结果 12例重症病例经RT-PCR检查EV71核酸阳性,其中男10例,女2例,中位数年龄1.96岁.发热持续时间6.5 d,皮疹持续时间7 d,起病至出现重症表现时间为3.7 d.神经系统受累10例,合并呼吸循环衰竭5例.5例X线胸片显示两肺或单侧片状阴影,4例为肺部纹理增多.白细胞计数、血糖、血沉和C-反应蛋白无特征性变化.11例选择大剂量静脉注射丙种球蛋白,7例使用甲泼尼龙治疗;4例肺水肿-呼吸衰竭患儿经呼吸机辅助通气,平均支持72(48～96)h.11例治愈,1例死亡.结论 EV71重症主要发生在年龄小于3岁患儿,以中枢神经系统感染为主,半数可发展为呼吸循环衰竭.早期使用呼吸机辅助呼吸对纠正呼吸循环衰竭,防止多脏器功能不全和降低死亡率尤为重要.     

外周血单个核细胞感染乙型肝炎病毒对新生儿宫内感染的影响

目的 :探讨 HBs Ag、 HBe Ag阳性孕妇外周血单个核细胞 ( PBMC)内乙型肝炎病毒 ( HBV) DNA感染状况及其在宫内母婴垂直传播中的作用。方法 :对 HBs Ag/ HBe Ag双阳性共 6 7对孕妇及其新生儿静脉血分离和提纯 PBMC后 ,经抽提、纯化后的 DNA进入 PCR扩增反应 ,引物为 HBV C区基因序列。结果 :6 7例 HBs Ag及 HBe Ag双阳性的孕妇中有 35例 ( 5 2 .2 % )PBMC中 HBV DNA阳性 ,2 5例孕妇在血清及 PBMC中均发现 HBV DNA。6 7例新生儿有 2 2例感染 HBV DNA,感染率 32 .8% ,其中血清 HBV DNA阳性者 10例 ,PBMC HBV DNA阳性者 19例 ,二者均阳性者 7例。结论 :母亲 PBMC内 HBV DNA阳性可能导致新生儿 PBMC中 HBV DNA阳性 ,PBMC内的 HBV DNA可能是 HBV母婴垂直传播的一条重要途径 ,同时 ,HBs Ag及HBe Ag阳性母亲若血清 HBV DNA为阳性就极大增加了其新生儿感染 HBV的危险性