磁敏感加权成像在帕金森病中的应用研究

目的:探索帕金森病(PD)的磁敏感加权成像(SWI)的表现。方法:34例帕金森病患者作为病例组和30例正常人作为对照组,采用GE1.5T磁共振成像系统,行常规的快速自旋回波T1、T2加权像后,加扫三维磁敏感加权成像覆盖基底节区及中脑。使用SWI后处理软件在校正相位图上两次测量双侧尾状核头、苍白球、壳核、黑质、红核的相位值,最终的相位值取两次测量的平均值。结果:病例组患者黑质、壳核的相位值较对照组明显降低,差异具有统计学意义(P<0.05),PD患者黑质及壳核铁沉积增加。病例组壳核的相位值与PD病程之间存在负相关。对照组中尾状核头、壳核、黑质相位值左侧低于右侧。结论:SWI是显示PD患者脑内铁沉积的有效的检查方法。     

MALDI Imaging Mass Spectrometry of Neuropeptides in Parkinson's Disease

MALDI imaging mass spectrometry (IMS) is a powerful approach that facilitates the spatial analysis of molecular species in biological tissue samples² (Fig.1). A 12 μm thin tissue section is covered with a MALDI matrix, which facilitates desorption and ionization of intact peptides and proteins that can be detected with a mass analyzer, typically using a MALDI TOF/TOF mass spectrometer. Generally hundreds of peaks can be assessed in a single rat brain tissue section. In contrast to commonly used imaging techniques, this approach does not require prior knowledge of the molecules of interest and allows for unsupervised and comprehensive analysis of multiple molecular species while maintaining high molecular specificity and sensitivity². Here we describe a MALDI IMS based approach for elucidating region-specific distribution profiles of neuropeptides in the rat brain of an animal model Parkinson''s disease (PD). PD is a common neurodegenerative disease with a prevalence of 1% for people over 65 of age^3,4. The most common symptomatic treatment is based on dopamine replacement using L-DOPA⁵. However this is accompanied by severe side effects including involuntary abnormal movements, termed L-DOPA-induced dyskinesias (LID)^1,3,6. One of the most prominent molecular change in LID is an upregulation of the opioid precursor prodynorphin mRNA⁷. The dynorphin peptides modulate neurotransmission in brain areas that are essentially involved in movement control^7,8. However, to date the exact opioid peptides that originate from processing of the neuropeptide precursor have not been characterized. Therefore, we utilized MALDI IMS in an animal model of experimental Parkinson''s disease and L-DOPA induced dyskinesia. MALDI imaging mass spectrometry proved to be particularly advantageous with respect to neuropeptide characterization, since commonly used antibody based approaches targets known peptide sequences and previously observed post-translational modifications. By contrast MALDI IMS can unravel novel peptide processing products and thus reveal new molecular mechanisms of neuropeptide modulation of neuronal transmission. While the absolute amount of neuropeptides cannot be determined by MALDI IMS, the relative abundance of peptide ions can be delineated from the mass spectra, giving insights about changing levels in health and disease. In the examples presented here, the peak intensities of dynorphin B, alpha-neoendorphin and substance P were found to be significantly increased in the dorsolateral, but not the dorsomedial, striatum of animals with severe dyskinesia involving facial, trunk and orolingual muscles (Fig. 5). Furthermore, MALDI IMS revealed a correlation between dyskinesia severity and levels of des-tyrosine alpha-neoendorphin, representing a previously unknown mechanism of functional inactivation of dynorphins in the striatum as the removal of N-terminal tyrosine reduces the dynorphin''s opioid-receptor binding capacity⁹. This is the first study on neuropeptide characterization in LID using MALDI IMS and the results highlight the potential of the technique for application in all fields of biomedical research.     

Dopaminergic Neuronal Imaging in Genetic Parkinson's Disease: Insights into Pathogenesis

Objectives

To compare the dopaminergic neuronal imaging features of different subtypes of genetic Parkinson''s Disease.

Methods

A retrospective study of genetic Parkinson''s diseases cases in which DaTSCAN (123I-FP-CIT) had been performed. Specific non-displaceable binding was calculated for bilateral caudate and putamen for each case. The right:left asymmetry index and striatal asymmetry index was calculated.

Results

Scans were available from 37 cases of monogenetic Parkinson''s disease (7 glucocerebrosidase (GBA) mutations, 8 alpha-synuclein, 3 LRRK2, 7 PINK1, 12 Parkin). The asymmetry of radioligand uptake for Parkinson''s disease with GBA or LRRK2 mutations was greater than that for Parkinson''s disease with alpha synuclein, PINK1 or Parkin mutations.

Conclusions

The asymmetry of radioligand uptake in Parkinsons disease associated with GBA or LRRK2 mutations suggests that interactions with additional genetic or environmental factors may be associated with dopaminergic neuronal loss.     

Kinetic Curve Type Assessment for Classification of Breast Lesions Using Dynamic Contrast-Enhanced MR Imaging

ObjectiveThe aim of this study was to employ a kinetic model with dynamic contrast enhancement-magnetic resonance imaging to develop an approach that can efficiently distinguish malignant from benign lesions.ResultsAn average sensitivity of 82%, a specificity of 65%, an area under the receiver operating characteristic curve of 0.76, and a positive predictive value of 82% and negative predictive value of 63% was shown with the kinetic model (p = 0.017, 0.052, 0.068), as compared to an average sensitivity of 80%, a specificity of 55%, an area under the receiver operating characteristic of 0.69, and a positive predictive value of 79% and negative predictive value of 57% with the time-signal intensity curve method (p = 0.003, 0.004, 0.008). The diagnostic consistency of the three radiologists was shown by the κ-value, 0.857 (p<0.001) with the method based on the time-signal intensity curve and 0.826 (p<0.001) with the method of the kinetic model.ConclusionsAccording to the statistic results based on the 46 lesions, the kinetic modeling curve method showed higher sensitivity, specificity, positive and negative predictive values as compared with the time-signal intensity curve method in lesion classification.     

MR 脑图像海马自动分割法在AD 早期诊断中的应用研究

目的:研究磁共振(Magnetic resonance,MR)脑图像中海马的自动分割方法及海马的形态学分析方法,为阿尔茨海默病(Alzheimer’s disease,AD)的早期诊断提供依据。方法:对20例AD患者和60名正常对照者行MRI T1 WI 3D容积扫描,建立海马的三维主动表观模型,并以此模型对每个个体脑部磁共振图像上的海马进行自动识别和三维分割,分别建立正常对照组和AD组的海马统计形状模型,比较AD组与正常对照组间海马形状的差异性。结果:海马三维分割方法与手动分割方法在海马体积测量上无统计学差别(P>0.05);AD患者海马头部发生萎缩(P<0.05)。结论:基于主动表观模型的MR脑图像海马自动识别和三维分割法是准确可靠的;海马头部萎缩可作为AD诊断的依据之一。     

蛇毒酶对帕金森氏病和帕金森综合征的治疗研究

目的研究观察蛇毒酶治疗帕金森氏病（ＰＤ）、帕金森综合征（ＰＳ）的临床效果,方法对８２例ＰＤ和ＰＳ患者进行随机分组,Ａ组应用精制蝮蛇抗栓酶,Ｂ组应用东菱克栓酶,Ｃ组应用力源精纯溶栓酶;对每例病人进行治疗前后Ｗｅｂｓｔｅｒ记分和记录多巴制剂的递减／递增量,同时检测血液流变学和血凝学５项指标,并给予统计比较,结果Ａ组病例不论是临床症状的改善,还是多巴制剂的用量递减、血液流变学和血凝学指标变化均优于Ｂ、Ｃ     

Markers of Disease Severity Are Associated with Malnutrition in Parkinson's Disease

Objective

In Parkinson''s disease (PD), commonly reported risk factors for malnutrition in other populations commonly occur. Few studies have explored which of these factors are of particular importance in malnutrition in PD. The aim was to identify the determinants of nutritional status in people with Parkinson''s disease (PWP).

Methods

Community-dwelling PWP (>18 years) were recruited (n = 125; 73M/52F; Mdn 70 years). Self-report assessments included Beck''s Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI), Scales for Outcomes in Parkinson''s disease – Autonomic (SCOPA-AUT), Modified Constipation Assessment Scale (MCAS) and Freezing of Gait Questionnaire (FOG-Q). Information about age, PD duration, medications, co-morbid conditions and living situation was obtained. Addenbrooke''s Cognitive Examination (ACE-R), Unified Parkinson''s Disease Rating Scale (UPDRS) II and UPDRS III were performed. Nutritional status was assessed using the Subjective Global Assessment (SGA) as part of the scored Patient-Generated Subjective Global Assessment (PG-SGA).

Results

Nineteen (15%) were malnourished (SGA-B). Median PG-SGA score was 3. More of the malnourished were elderly (84% vs. 71%) and had more severe disease (H&Y: 21% vs. 5%). UPDRS II and UPDRS III scores and levodopa equivalent daily dose (LEDD)/body weight(mg/kg) were significantly higher in the malnourished (Mdn 18 vs. 15; 20 vs. 15; 10.1 vs. 7.6 respectively). Regression analyses revealed older age at diagnosis, higher LEDD/body weight (mg/kg), greater UPDRS III score, lower STAI score and higher BDI score as significant predictors of malnutrition (SGA-B). Living alone and higher BDI and UPDRS III scores were significant predictors of a higher log-adjusted PG-SGA score.

Conclusions

In this sample of PWP, the rate of malnutrition was higher than that previously reported in the general community. Nutrition screening should occur regularly in those with more severe disease and depression. Community support should be provided to PWP living alone. Dopaminergic medication should be reviewed with body weight changes.     

Olfactory Training in Patients with Parkinson's Disease

Objective

Decrease of olfactory function in Parkinson''s disease (PD) is a well-investigated fact. Studies indicate that pharmacological treatment of PD fails to restore olfactory function in PD patients. The aim of this investigation was whether patients with PD would benefit from “training” with odors in terms of an improvement of their general olfactory function. It has been hypothesized that olfactory training should produce both an improved sensitivity towards the odors used in the training process and an overall increase of olfactory function.

Methods

We recruited 70 subjects with PD and olfactory loss into this single-center, prospective, controlled non-blinded study. Thirty-five patients were assigned to the olfactory training group and 35 subjects to the control group (no training). Olfactory training was performed over a period of 12 weeks while patients exposed themselves twice daily to four odors (phenyl ethyl alcohol: rose, eucalyptol: eucalyptus, citronellal: lemon, and eugenol: cloves). Olfactory testing was performed before and after training using the “Sniffin'' Sticks” (thresholds for phenyl ethyl alcohol, tests for odor discrimination, and odor identification) in addition to threshold tests for the odors used in the training process.

Results

Compared to baseline, trained PD patients experienced a significant increase in their olfactory function, which was observed for the Sniffin'' Sticks test score and for thresholds for the odors used in the training process. Olfactory function was unchanged in PD patients who did not perform olfactory training.

Conclusion

The present results indicate that olfactory training may increase olfactory sensitivity in PD patients.     

Behavioral Phenotyping of Parkin-Deficient Mice: Looking for Early Preclinical Features of Parkinson's Disease

There is considerable evidence showing that the neurodegenerative processes that lead to sporadic Parkinson''s disease (PD) begin many years before the appearance of the characteristic motor symptoms. Neuropsychiatric, sensorial and cognitive deficits are recognized as early non-motor manifestations of PD, and are not attenuated by the current anti-parkinsonian therapy. Although loss-of-function mutations in the parkin gene cause early-onset familial PD, Parkin-deficient mice do not display spontaneous degeneration of the nigrostriatal pathway or enhanced vulnerability to dopaminergic neurotoxins such as 6-OHDA and MPTP. Here, we employed adult homozygous C57BL/6 mice with parkin gene deletion on exon 3 (parkin ^−/−) to further investigate the relevance of Parkin in the regulation of non-motor features, namely olfactory, emotional, cognitive and hippocampal synaptic plasticity. Parkin ^−/− mice displayed normal performance on behavioral tests evaluating olfaction (olfactory discrimination), anxiety (elevated plus-maze), depressive-like behavior (forced swimming and tail suspension) and motor function (rotarod, grasping strength and pole). However, parkin ^−/− mice displayed a poor performance in the open field habituation, object location and modified Y-maze tasks suggestive of procedural and short-term spatial memory deficits. These behavioral impairments were accompanied by impaired hippocampal long-term potentiation (LTP). These findings indicate that the genetic deletion of parkin causes deficiencies in hippocampal synaptic plasticity, resulting in memory deficits with no major olfactory, emotional or motor impairments. Therefore, parkin ^−/− mice may represent a promising animal model to study the early stages of PD and for testing new therapeutic strategies to restore learning and memory and synaptic plasticity impairments in PD.     

Early and Late Gene Changes in MPTP Mice Model of Parkinson's Disease Employing cDNA Microarray

Recently, we reported specific brain gene expression changes in the chronic MPTP model in the late stage of degeneration, employing cDNA expression array, which indicate a domino cascade of events involved in neuronal cell death. In an attempt to elucidate early gene expression profile in the region of the substantia nigra (SN) and the striatum of acute MPTP-treated mice (3–24 h), we elected a restricted number of genes affected by the long-term MPTP treatment, and their expression was examined. Specifically, we detected alterations in the expression of genes implicated in oxidative-stress, inflammatory processes, signal transduction and glutamate toxicity. These pro-toxic genes appear to be compensated by the elevated expression in trophic factors and antioxidant defenses, which are also activated by short exposure to MPTP. The time course of these gene expression changes indicates the importance of investigating the early gene cascade of events occurring prior to late nigrostriatal dopamine neuronal cell death.     

Multi-Reception Strategy with Improved SNR for Multichannel MR Imaging

A multi-reception strategy with extended GRAPPA is proposed in this work to improve MR imaging performance at ultra-high field MR systems with limited receiver channels. In this method, coil elements are separated to two or more groups under appropriate grouping criteria. Those groups are enabled in sequence for imaging first, and then parallel acquisition is performed to compensate for the redundant scan time caused by the multiple receptions. To efficiently reconstruct the data acquired from elements of each group, a specific extended GRAPPA was developed. This approach was evaluated by using a 16-element head array on a 7 Tesla whole-body MRI scanner with 8 receive channels. The in-vivo experiments demonstrate that with the same scan time, the 16-element array with twice receptions and acceleration rate of 2 can achieve significant SNR gain in the periphery area of the brain and keep nearly the same SNR in the center area over an eight-element array, which indicates the proposed multi-reception strategy and extended GRAPPA are feasible to improve image quality for MRI systems with limited receive channels. This study also suggests that it is advantageous for a MR system with N receiver channels to utilize a coil array with more than N elements if an appropriate acquisition strategy is applied.     

Treatment of Parkinson's Disease with L-Dopa: A Current Appraisal

Interest in l-dopa therapy for Parkinson''s disease has been considerably enhanced since the recent release of this drug to all medical practitioners. Our experience in the use of l-dopa in 83 patients who have been treated during the past 22 months is presented to provide a practical approach to the administration of l-dopa. Many parkinsonian patients can be treated advantageously on an outpatient basis without the need for initial hospitalization. Some of the common side effects of l-dopa administration can be averted or controlled by a cautious and slow build-up to the optimal dosage level. In the majority (78%) of parkinsonian patients who had been carefully selected for treatment the drug had a beneficial effect on akinesia and rigidity. In the remainder, therapy had to be discontinued because of undesirable side effects or a limited response.     

Results of Thalamotomy for Parkinson's Disease

Surgical destruction of a portion of the ventrolateral nucleus of the thalamus is currently the procedure of choice for the treatment of incapacitating tremor and rigidity of parkinsonism. Seventy-three patients were treated by 105 thalamotomies at the University of Alberta Hospital and assessed one to four years later for improvement of function in everyday activities. Fifty-six patients were improved, 12 were unchanged, and five had died. Only two of the deaths were related to the operation. Paresis was permanent in only one patient. Twenty-five patients had bilateral operations and 22 of these showed improvement of function. Contraindications to operation include serious cardiovascular disease, mental deterioration, and those parkinsonian patients whose disability is chiefly due to akinesia, oculogyric crisis, dysphasia or dysarthria.     

One to Two Year Treatment of Parkinson's Disease with Levodopa

One hundred patients with Parkinson''s disease were treated with levodopa for more than a year at UCLA Medical Center. They were examined at given intervals and their improvement was graded. The optimum therapeutic dose was attained by balancing side effects against relief of symptoms and ranged from 1.5 grams to 8.0 grams per day (average 4.3 grams). There is no doubt that levodopa is the most effective treatment now available for Parkinson''s disease. At the end of the first year, 60 percent of the patients improved 50 percent or better, and 10 percent were considered symptom-free. All major symptoms of this disease, including rigidity, akinesia and tremor, improved in variable degree.There were no serious abnormalities in the routine clinical laboratory tests. The comon side effects included nausea, vomiting and choreoathetoid dyskinesias. The side effects were not life threatening, but occasionally were major therapeutic challenges.Maximal benefits with minimal side effects were achieved only by careful adjustments of the levodopa dosage as the months went by. This needed careful management by the physician and cooperation by the patient. Anticholinergic medications or amantadine hydrochloride, sometimes both, usually supplemented the effect of the levodopa.