丘脑底核高频和低频电刺激治疗帕金森病的临床效果评价

目的:观察和比较丘脑底核高频电刺激与低频电刺激治疗帕金森病(PD)的临床效果。方法:对入选的31名PD患者行双侧丘脑底核电刺激手术,术后1个月,在高频刺激条件下,进行UPDRS运动评分,同时对震颤、强直、运动迟缓、中轴症状进行评分;术后6个月,在关闭刺激、高频刺激和低频刺激三种刺激条件,同样进行相关评分。结果:术后1个月和术后6个月,除中轴症状外,UPDRS运动评分和震颤、强直、运动迟缓评分均较术前明显降低(P0.05)。术后6个月,HFS、LFS刺激条件下,UPDRS运动评分和震颤、强直、运动迟缓评分均较OFF降低(P0.05),但中轴症状评分无明显降低(P0.05)。术后6个月,LFS较HFS,各项评分均无明显差异。结论:丘脑底核高频和低频电刺激均能改善PD的运动功能,对震颤、强直和运动迟缓疗效明显,但对中轴症状均无明显治疗效果。     

帕金森病伴抑郁患者DBS 术后帕罗西汀治疗疗效观察

目的:研究丘脑底核(STN)脑深部电刺激(DBS)治疗帕金森病(PD)合并抑郁障碍术后服用帕罗西汀治疗的疗效。方法:将38例合并抑郁障碍的PD患者随机分为三组,行丘脑底核脑深部电极植入术,术后空白对照组不服用任何抗抑郁药物,药物治疗组服用帕罗西汀每日一次,每次20mg,安慰剂组服用安慰剂。术前一周,术后1个月、2个月和3个月进行随访和临床评价。结果:抑郁患者术后抑郁障碍症状如焦虑、绝望和激越症状也有不同程度好转,应用安慰剂后,患者术后抑郁障碍程度好转程度大于空白对照组(P<0.05),而应用帕罗西汀后术后3个月汉密尔顿抑郁量表评分(HAMD)下降程度显著低于空白对照组及安慰剂组(P<0.05)。结论:表明STN-DBS术后PD患者的抑郁症状有所改善,辅助抗抑郁药物治疗效果更佳。     

帕金森病伴抑郁患者DBS术后帕罗西汀治疗疗效观察

目的：研究丘脑底核（STN）脑深部电刺激（DBS）治疗帕金森病（PD）合并抑郁障碍术后服用帕罗西汀治疗的疗效。方法：将38例合并抑郁障碍的PD患者随机分为三组,行丘脑底核脑深部电极植入术,术后空白对照组不服用任何抗抑郁药物,药物治疗组服用帕罗西汀每日一次,每次20mg,安慰剂组服用安慰剂。术前一周,术后1个月、2个月和3个月进行随访和临床评价。结果：抑郁患者术后抑郁障碍症状如焦虑、绝望和激越症状也有不同程度好转,应用安慰剂后,患者术后抑郁障碍程度好转程度大于空白对照组（P〈0.05）,而应用帕罗西汀后术后3个月汉密尔顿抑郁量表评分（HAMD）下降程度显著低于空白对照组及安慰剂组（P〈0.05）。结论：表明STN-DBS术后PD患者的抑郁症状有所改善,辅助抗抑郁药物治疗效果更佳。     

脑电治疗联合多巴丝肼对帕金森病运动症状的影响

目的观察脑电治疗联合多巴丝肼治疗帕金森病运动症状的效果及安全性。方法将2017年10月～2018年12月我院神经内科收治的临床确诊为帕金森病的60例患者随机分为干预组(30例)和对照组(30例)。对照组给予多巴丝肼连续治疗4周;干预组在多巴丝肼治疗基础上给予脑电治疗4周,每周5次,共20次。采用帕金森病综合评定量化表评估两组患者治疗前后的运动能力。比较两组治疗前后的临床疗效、运动能力评分及不良反应情况。结果干预组临床总有效率为90.0%(27/30),高于对照组的76.7%(23/30)(χ~2=8.027,P0.01)。两组治疗2、4周后的运动能力评分均明显低于治疗前(P0.05);干预组治疗4周后运动能力评分低于对照组(P0.05)。两组均未出现严重不良反应。结论脑电治疗联合多巴丝肼治疗帕金森病效果显著,可改善患者的运动症状,且安全性较高。     

丘脑底核-深部脑刺激术术后淡漠的研究进展

帕金森病(Parkinson's disease,PD)是一种由于中脑黑质以及其他核团结构的多巴胺能神经元变性所致的以进行性运动功能障碍为主要表现的疾病。近年来,双侧高频刺激的丘脑底核-深部脑刺激术(STN-DBS)治疗PD效果确切,疗效较好,但其出现了术后淡漠等类似副作用,严重影响了PD治疗效果和患者的生活质量,引起了临床医生的高度重视。本文对STN-DBS术后淡漠发病情况、表现及治疗进行综述,为临床诊治提供思路。     

阿托伐他汀钙对帕金森病细胞模型的保护作用及其临床意义

目的:评价阿托伐他汀钙对帕金森病细胞模型及帕金森病患者临床症状的影响。方法:首先使用MPP+处理SH-SY5Y细胞建立帕金森病细胞模型。观察阿托伐他汀钙在该模型中对Wnt通路以及细胞凋亡的影响。其次选取66例符合纳入标准的临床患者,其中33例服用多巴丝肼片和盐酸普拉克索(普通治疗组)。其余33例则因其他原因在使用多巴丝肼片和盐酸普拉克索治疗期间服用阿托伐他汀钙片(阿托伐他汀组)。观察两组患者的Hoehn-Yahr分级,UPDRS评分,以及不良反应的发生率。结果:在MPP+处理组,Wnt通路受到抑制且细胞发生凋亡,而阿托伐他汀钙预处理可缓解MPP+引起的Wnt通路的抑制和细胞凋亡,差异具有统计学意义(P0.05)。治疗8周后阿托伐他汀组的Hoehn-Yahr分级改善情况显著优于普通治疗组的改善情况,并且差异具有统计学意义(P0.05);治疗8周后普通治疗组的UPDRS评分高于阿托伐他汀组的评分,差异具有统计学意义(P0.05);阿托伐他汀组的不良反应发生率低于普通治疗组,但差异无统计学意义(P0.05)。结论:阿托伐他汀钙可通过Wnt通路保护MPP+引起的细胞凋亡并且在临床治疗中能较好的改善帕金森病患者的运动和非运动症状。     

脑深部电刺激的临床应用

脑深部电刺激(deep brain stimulation,DBS)是近20年来神经外科领域发展最迅猛的技术。DBS是通过刺激发生器发出的高频电脉冲信号刺激脑神经核团或神经传导束来调节异常的神经环路。DBS已经成为治疗特发性震颤、帕金森病、肌张力障碍等运动障碍病的常规手术方法。自1997年深部脑刺激通过美国FDA认证用于治疗特发性震颤以来,已有超过数万名运动障碍患者接受该疗法,而国内脑深部电刺激最早在1999年应用于帕金森病临床治疗,迄今也有数千例患者接受了植入手术。近年,脑起搏器的临床适应症不断扩大,从最初的运动障碍病逐渐发展到治疗其他神经和精神疾病,如抽动秽语综合征、强迫症、抑郁症、神经性厌食症、难治性疼痛、癫痫、植物状态和阿尔茨海默病等,虽然DBS的治疗机理还不很清楚,但可以预见未来DBS将成为众多神经和精神疾病的重要治疗方法。     

脑电治疗在帕金森病伴失眠症患者中的应用疗效观察

目的观察脑电治疗帕金森病伴失眠症患者的疗效。方法将我院神经内科收治的68例帕金森病伴失眠症的患者随机分为对照组和干预组各34例,对照组仅给予药物治疗,干预组在药物治疗基础上加用脑电治疗,观察两组患者治疗4周后的匹兹堡睡眠质量指数(PSQI)评分的变化情况,并采用帕金森病综合评分表(UPDRS)为量化指标评估两组患者治疗前后的临床效果。结果干预组的匹兹堡睡眠质量指数(PSQI)显著低于对照组,两组比较差异有统计学意义(P0.05)。治疗4周后,两组患者的UPDRS评分均较治疗前下降(P0.05),而干预组的评分下降较为显著,与对照比较差异有统计学意义(P0.05)。结论脑电治疗能有效改善帕金森病患者的失眠症状,而且能显著缓解帕金森病肌强直症状,安全性高,值得临床推广应用。     

多巴丝肼联合普拉克索治疗帕金森病的临床疗效

目的:探讨多巴丝肼联合普拉克索治疗帕金森病的临床疗效。方法:以入院病历号为编号,根据随机数字表,将106名帕金森病患者随机分成分两组,每组53例。治疗过程中,给予多巴丝肼片治疗的患者记为对照组(53例);给予多巴丝肼联合普拉克索治疗的患者记为观察组(53例)。连续治疗12周,观察两组患者总疗效、UPDRS评分、HAMD评分及不良反应,探讨其临床治疗价值。结果:1观察组总有效率明显高于对照组总有效率,差异有统计学意义(P0.05)。2与治疗前相比,治疗后两组UPDRS各项评分均明显改善(P0.05),且观察组UPDRS各项评分明显优于对照组(P0.05)。3与治疗前相比,治疗后两组HAMD评分均明显改善(P0.05),且观察组HAMD评分明显优于对照组(P0.05)。结论:多巴丝肼联合普拉克索治疗帕金森病疗效确切,安全可靠,值得临床推广应用。     

丘脑中央中核-束旁核复合体与帕金森病

丘脑中央中核-束旁核复合体具有多重功能,与大脑皮层和皮层下多个核团,尤其是纹状体有非常紧密的联系,在帕金森病的病理变化中起着重要作用。中央中核-束旁核在帕金森病患者呈现出形态学和电生理学上的异常改变,对中央中核-束旁核复合体进行高频刺激能明显的缓解帕金森病运动迟缓和震颤等症状,为帕金森病的治疗提供了一个新的靶点。     

Protein interaction network for Alzheimer's disease using computational approach

Alzheimer''s disease (AD) is the most common form of dementia. It is the sixth leading cause of death in old age people. Despite recent advances in the field of drug design, the medical treatment for the disease is purely symptomatic and hardly effective. Thus there is a need to understand the molecular mechanism behind the disease in order to improve the drug aspects of the disease. We provided two contributions in the field of proteomics in drug design. First, we have constructed a protein-protein interaction network for Alzheimer''s disease reviewed proteins with 1412 interactions predicted among 969 proteins. Second, the disease proteins were given confidence scores to prioritize and then analyzed for their homology nature with respect to paralogs and homologs. The homology persisted with the mouse giving a basis for drug design phase. The method will create a new drug design technique in the field of bioinformatics by linking drug design process with protein-protein interactions via signal pathways. This method can be improvised for other diseases in future.     

Effect of amyloids on the vesicular machinery: implications for somatic neurotransmission

Certain neurodegenerative diseases are thought to be initiated by the aggregation of amyloidogenic proteins. However, the mechanism underlying toxicity remains obscure. Most of the suggested mechanisms are generic in nature and do not directly explain the neuron-type specific lesions observed in many of these diseases. Some recent reports suggest that the toxic aggregates impair the synaptic vesicular machinery. This may lead to an understanding of the neuron-type specificity observed in these diseases. A disruption of the vesicular machinery can also be deleterious for extra-synaptic, especially somatic, neurotransmission (common in serotonergic and dopaminergic systems which are specifically affected in Alzheimer''s disease (AD) and Parkinson''s disease (PD), respectively), though this relationship has remained unexplored. In this review, we discuss amyloid-induced damage to the neurotransmitter vesicular machinery, with an eye on the possible implications for somatic exocytosis. We argue that the larger size of the system, and the availability of multi-photon microscopy techniques for directly visualizing monoamines, make the somatic exocytosis machinery a more tractable model for understanding the effect of amyloids on all types of vesicular neurotransmission. Indeed, exploring this neglected connection may not just be important, it may be a more fruitful route for understanding AD and PD.     

多奈哌齐治疗阿尔兹海默症患者的临床剂量使用探讨

目的:评价多奈哌齐治疗阿尔兹海默症(AD)的疗效及疗效与用药剂量的关系,探讨检测血清中胰岛素样生长因子-I(IGF-I)来指导治疗剂量的可行性。方法:87例轻中度的AD患者,患者使用5 mg/d多奈哌齐疗效不佳。在增加剂量之前,根据血清胰岛素样生长因子-I(IGF-I)水平和简易智力状态检查表(MMSE)得分之间的一致性,将患者分为3组。A组:n=27,IGF-I≤99ng/m L,MMSE≤37;B组:n=33,IGF-I≤99 ng/m L,MMSE18;C组:n=27,IGF-I99 ng/m L,MMSE18。A、B组中,血清IGF-I水平显著低于C组。试验开始后将多奈哌齐的剂量从5 mg/d增加到10 mg/d,服用12周后,观察血清IGF-I水平同MMSE和阿尔兹海默症评定量表(ADAS)得分的相关性及三组患者的临床改善情况。结果:血清IGF-I水平同认知功能有明显相关性。IGF-I同MMSE正相关(r=0.478,P=0.036),IGF-I同ADAS得分负相关(r=-0.464,P=0.029)。增加多奈哌齐(10 mg/d)剂量治疗后,只有A组患者MMSE得到显著改善。A组患者对治疗的敏感性显著高于B、C组患者。结论:血清中IGF-I水平和MMSE分值可以做为一种标志物,判断对低剂量多奈哌齐(5 mg/d)无效的轻中度AD患者,能否采用高剂量多奈哌齐(10 mg/d)进行治疗。     

Cost-effectiveness analysis for triple markers serum screening for Down's syndrome in Thai setting

BACKGROUND:

Down''s syndrome is an important congenital chromosomal disorder that can be seen around the world. The antenatal screening for this disorder is an important processing in present obstetrics.

OBJECTIVE:

Due to the concept of first do no harm, the use of noninvasive test is recommended. The triple marker screening test has been introduced for a few years and acceptable for its efficacy.

RESULT:

However, an important concern is on its cost-effectiveness. Here, the author analyze and present the cost-effectiveness of the triple markers serum screening for Down''s syndrome in Thai setting.

CONCLUSION:

According to this work, the cost per effectiveness of triple markers serum screening is slightly lower than standard amniocentesis test.     

帕金森病的细胞治疗研究进展

干细胞为治疗帕金森病提供了新的希望.目前用于研究的干细胞主要有神经干细胞、胚胎干细胞、诱导多功能干细胞、间充质干细胞等.本文回顾了上述细胞在移植治疗帕金森病研究中的进展,并介绍了近期出现的将体细胞直接重编程为神经细胞或神经干细胞的新技术.     

阿尔茨海默病运动治疗研究进展

阿尔茨海默病(Alzheimer's disease,AD)是一种神经退行性疾病,目前对其发病机制尚未完全阐明,治疗效果也不佳。最近不少研究者根据运动对人体,特别是对脑的益处,提出运动治疗AD的可能。本文综述了运动治疗AD的研究进展及其可能机制,展望其可能的治疗前景。     

操纵茶树类黄酮3′-羟基化酶生物合成B环-3′,4′-二羟基黄酮类化合物

【目的】操纵茶树类黄酮3′-羟基化酶,生物合成B环-3′,4′-二羟基黄酮类化合物圣草酚、二氢槲皮素和槲皮素。【方法】构建了4个茶树类黄酮3′-羟基化酶基因(CsF3′H)和拟南芥的P450还原酶基因(ATR)融合表达质粒:SUMO-CsF3'H[7-517]::ATR1[49-688]3 AA、SUMO-CsF3'H[28-517]::ATR1[49-688]3 AA、SUMO-CsF3'H[7-517]::ATR2[75-711]3 AA和SUMO-CsF3'H[28-517]::ATR2[75-711]3 AA,分别转化大肠杆菌菌株TOP10、DH5α和BL21,获得12个转化菌株S1–S12;构建了茶树类黄酮3′-羟基化酶基因CsF3′H表达质粒p YES-Dest52-CsF3′H,转化酵母菌株WAT11,得到转化菌株S13;构建了茶树类黄酮3′-羟基化酶基因CsF3′H表达质粒pES-URA-CsF3′H,及茶树黄烷酮3-羟基化酶基因CsF3H与拟南芥黄酮醇合成酶基因At FLS的融合表达质粒pES-HIS-CsF3H::At FLS 9AA,二者共转化酵母菌株WAT11,获得转化菌株S14。【结果】转化SUMO-CsF3'H[28-517]::ATR1[49-688]3 AA质粒的TOP10菌株S6在25°C条件下发酵,转化效率最高,能将1000μmol/L柚皮素、二氢山奈酚和山奈酚,分别转化生成287.93μmol/L圣草酚、131.76μmol/L二氢槲皮素和188.62μmol/L槲皮素。发酵菌株S13能分别将1000μmol/L柚皮素、二氢山奈酚和山奈酚,最多能转化生成734.32μmol/L圣草酚、446.07μmol/L二氢槲皮素和594.64μmol/L槲皮素。喂食S14发酵菌株5 mmol/L的底物柚皮素,在发酵36–48 h中,最多能生成1412.16μmol/L圣草酚、490.25μmol/L山奈酚、445.75μmol/L槲皮素、66.75μmol/L二氢槲皮素和73.50μmol/L二氢山奈酚。【结论】本研究首次将茶树类黄酮3′-羟基化酶基因应用于B环-3′,4′-二羟基黄酮类化合物圣草酚、二氢槲皮素和槲皮素的生物合成。     

基于益生菌治疗帕金森病的研究进展

帕金森病是常见的神经退行性疾病,其发病原因至今尚未明确,目前的治疗方法价格昂贵、效果差且副作用大。帕金森病患者常见胃肠道功能障碍,帕金森病和肠道菌群之间的关联已得到实验证实,患者有望通过益生菌改善肠道菌群达到治疗的目的。工程益生菌的出现使得人们可以按照自己的意愿改造益生菌,提高其稳定性和靶向性,展现出其特有的应用潜力。本文将从益生菌治疗帕金森病的研究现状出发,阐述益生菌治疗帕金森病的可能机制,进一步分析工程益生菌治疗帕金森病的可行性,为该疾病的安全治疗提供新的思路。     

Frequency of premolar teeth extractions for orthodontic treatment

It is of interest to evaluate the frequency of premolar extractions during orthodontic treatment in patients reporting to the Saveetha dental hospital in Chennai from 2019-2020. We used the records from 987 patients who underwent orthodontic treatment from June 2019 to March 2020 in a dental hospital for this analysis. Digital case records of patients who underwent therapeutic extractions of premolars were isolated. A sample dataset of 340 case records were selected for this study. Data shows that 34.4% of subjects underwent premolar extractions amongst a total of 987 subjects who underwent orthodontic treatment. 89.4% of patients were Angle''s Class I malocclusion patients, and the rest were Class II patients. However, no premolar extractions were done in Class III patients. Data also shows that 67.1% of subjects underwent all 4 first premolar extractions and 13.2% underwent only upper first premolar extractions. Thus, a significant association was found between Type of Malocclusion and the Type of premolar extractions with p < 0.05. Moreover, only 34.4% of patients underwent premolar extractions and the majority of them underwent all 4 first premolar extractions.