不同类型急性白血病的神经病征与转归

不同类型急性白血病的神经病征与转归曾小菁，李卓江急性白血病（ＡＬ）的神经系统受累是常见致死原因之一。观察不同类型ＡＬ出现神经病征的频数及与转归的关系，有助于深入认识各型ＡＬ临床征象，选择最佳治疗方案及估计预后。１临床资料ＡＬ患者１０１例均为我院血液科...

利兹神经病理性症状和体征评分与疼痛强度的关系

目的:探索慢性腰痛病人利兹神经病理性症状和体征疼痛评分(leeds assessment of neuropathic symptoms and sign,LANSS)与疼痛强度的关系。方法:(1)三家研究中心(北京大学人民医院、中日友好医院和南京军区南京总医院)入选的慢性腰痛病人填写LANSS量表及疼痛数字评分量表(numerical rating scale,NRS)。(2)使用spearman相关分析评价LANSS量表评分与疼痛强度的关系。结果:入组2115例慢性腰痛病人,总合格率为90.0%,调查对象平均年龄为50.1±15.6年,合格病人中男778例,女1125例。LANSS评分中值随疼痛强度的增加有一定的增长,但是两者的spearman秩相关系数小于0.4,且LANSS量表各项评分与疼痛强度的spearman秩相关系数均小于0.4。结论:中文版LANSS评分随疼痛强度的增加有一定的上升趋势,但是两者并无相关性。

循证综述:慢性腰痛和软组织综合征存在神经病理性疼痛的证据

目的:本综述旨在提供慢性腰痛和软组织综合征与神经病理性疼痛是否相关的证据,以及两者中神经病理性疼痛的患病率。方法:研究的816例患者中,11例慢性腰痛患者存在神经病理性疼痛诊断,5例软组织综合征患者存在神经病理性疼痛诊断。研究分组依据神经病理性疼痛的诊断方法,如体格检查、神经病理性疼痛量表类型等。神经病理性疼痛的患病率为各组研究中所有患者的合计。慢性腰痛和软组织综合征中神经病理性疼痛的患病率为两者各自研究中所有患者的总和。两名评价者独立根据11项质量标准对每个研究做出质量评分,依据卫生保健政策和研究机构(AHCPR)指南评估各分组证据的强度和一致性。结果:各分组中所有研究报道均存在神经病理性疼痛。慢性腰痛中神经病理性疼痛的患病率是36.6%,软组织综合征中神经病理性疼痛的患病率是41.1%。不同的神经病理性疼痛诊断方法间患病率存在显著差异。结论:所有的方法一致证实,慢性腰痛和软组织综合征患者中存在神经病理性疼痛,且合并患病率显著。这对慢性腰痛和软组织综合征的治疗有重要意义。

3种神经病理性疼痛筛查量表在中轴型脊柱关节炎患者中的评价

目的 比较3种神经病理性疼痛筛查量表在中轴型脊柱关节炎患者中的信度、效度和适用性。方法 采用painDETECT问卷、神经病理性疼痛4问卷和利兹神经病理性症状和体征评估疼痛量表对186例中轴型脊柱关节炎患者进行调查,评价量表的信度和效度。结果 painDETECT问卷、神经病理性疼痛4问卷和利兹神经病理性症状和体征评估疼痛量表的Cronbach α系数分别为0.807,0.697和0.623, Guttman分半系数分别为0.846、0.691和0.701。painDETECT问卷共提取2个公因子,累计方差贡献率55.171%。神经病理性疼痛4问卷共提取4个公因子,累计方差贡献率66.627%。利兹神经病理性症状和体征评估疼痛量表共提取2个公因子,累计方差贡献率50.836%。3种量表评估结果一致性Kappa值和相关性r值均大于0.500。患者对3种量表首选率分别为71.5%、3.2%和14.0%。结论 painDETECT问卷信度和效度良好,首选率最高。其余2种量表信度尚可,效度良好。3种量表一致性与相关性较强。

Increased prevalence of symptoms of gastroesophageal reflux diseases in type 2 diabetics with neuropathy

AIM： To analyze the prevalence of gastroesophageal reflux disease （GERD） related symptoms in patients with diabetes mellitus （DM） and to find out the relationship between diabetic neuropathy and the prevalence of GERD symptoms. METHODS： In this prospective questionnaire study, 150 consecutive type 2 diabetic patients attending the endocrine clinic were enrolled. A junior physician helped the patients to understand the questions. Patients were asked about the presence of five most frequent symptoms of GERD that included heartburn （at least 1/wk）, regurgitation, chest pain, hoarseness of voice and chronic cough. Patients with past medical history of angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes and apparent psychiatric disorders were excluded from the survey. We further divided the patients into two groups based on presence or absence of peripheral neuropathy. Out of 150 patients, 46 had neuropathy, whereas 104 patients did not have neuropathy. Data are expressed as mean ± SD, and number of patients in each category and percentage of total patients in that group. Normal distributions between groups were compared with Student t test and the prevalence rates between groups were compared with Chi-square tests for significance. RESULTS： The average duration of diabetes were 12 ± 9.2 years and the average HbAlc level of this group was 7.7% ± 2.0%. The mean weight and BMI were 198 ± 54 Ibs. and 32 ± 7.2 kg/m^2. Forty percent （61/150） patients reported having at least one of the symptoms of GERD and thirty percent （45/150） reported having heartburn at least once a week. The prevalence of GERD symptoms is higher in patients with neuropathy than patients without neuropathy （58.7% vs 32.7%, P 〈 0.01）. The prevalence of heartburn, chest pain and chronic cough are also higher in patients with neuropathy than in patients without neuropathy （43.5% vs 24%; 10.9% vs 4.8% and 17.8% vs 6.7% respectively, P 〈 0.05）. CONCLUSION： The prevalence of GERD symptoms in type 2 DM is higher than in the general population. Our data suggest that DM neuropathy may be an important associated factor for developing GERD symptoms.

Molecular Study on Differentiation-Associated Genes Involved in Both Malignant Progression of Glioma and Differentiation of Human Fetal Neural Stem Cells

OBJECTIVE It is unclear whether differentiation disturbances or deregulation of neural stem cells (NSCs) are the early key steps for gliomagenesis and tumor development. Furthermore, relevant molecular changes and gene-regulation pathways are unknown. This study focused on screening and validating differentiation-associated genes from both human NSCs and glioma cells with malignant progression, for the purpose of offering an experimental basis for the cellular origin of gilomas and molecular pathology of gliomagenesis. METHODS The differential-gene expression profiles of malignant progression of gliomas were established, then the differentiation related genes were screened out with a bioinformatics analysis. Expression levels of these genes was further analyzed in cultured human fetal NSCs undergoing differentiation processes with a semi-quantitative RT-PCR assay. RESULTS Eight genes were screened out from the gene-expression profiling of which the expression levels were associated with the differentiation processes of NSCs, namely CXCR4, TN-C, GLT1, IL1-RI, EGFR-8, CDC2, Ndr3 and MAPKK4. Three of them, ie., GLT1, CDC2 and MAPKK4, were further analyzed, showing that expression levels decreased with the differentiation processes of NSCs, and increased with the malignant progression of ganglioglioma. CONCLUSION Three differentiation associated genes were found negatively associated with NSCs differentiation and positively associated with malignant progression of gliomas, suggesting that differentiation disturbances of neural stem cells may be involved in oncogenesis, and that further studies on their roles in gliomagenesis should be conducted.

Need for a comprehensive medical approach to the neuroimmuno-gastroenterology of irritable bowel syndrome

Irritable bowel syndrome （IBS） is defined by the Rome ]I[ criteria as symptoms of recurrent abdominal pain or discomfort with the onset of a marked change in bowel habits with no evidence of an inflammatory, anatomic, metabolic, or neoplastic process. As such, many clinicians regard IBS as a central nervous system problem of altered pain perception. Here, we review the recent literature and discuss the evidence that supports an organic based model, which views IBS as a complex, heterogeneous, inter-dependent, and multi-variable inflammatory process along the neuronal-gut axis. We delineate the organic pathophysiology of IBS, demonstrate the role of inflammation in IBS, review the possible differences between adult and pediatric IBS, discuss the merits of a comprehensive treatment model as taught by the Institute of Functional Medicine, and describe the potential for future research for this syndrome.

Fire needle combined with blood-letting therapy for a case of 20-year trigeminal neuralgia

Background： Trigeminal neuralgia （TN） is a neuropathic pain syndrome. It is the most frequent cranial neuralgia and defined as sudden, usually unilateral and lightning-like, knife-like or burning-like recurrent episodes of pain within the distribution area of one or more divisions of the trigeminal nerve. Here we reported that an 81-year-old woman with TN who complained of severe pain on her right face showed a complete clinical relief after comprehensive therapy containing fire needle, filiform needle and blood-letting therapy. Methods： The patient was applied fire needle combined with filiform needle therapy （3 times / week for 4 months） and three consecutive fire needle combined with blood-letting therapy （3 times / week for one week）. Fire needle was inserted into the back points of Du meridian, the first lateral line of bladder meridian, the right spreading area of the trigeminal nerve and the points around the pain radiation site. The filiform needle acupuncture was applied to the points on the right face including Yuyao （EX-HN4）, Yangbai （GB14）, Toulinqi （GB15）, et al; points on the abdomen including Xiawan （RN10）, Qihai （RN16）, Guanyuan （RN14） and the bilateral points including Tianshu （ST25）, Daheng （SP15）, Zusanli （ST36）, et al. Finally, the three-edged fire needle punctured the points of Yangbai （GB41）, Shangguan （GB3）, Jiache （ST6） on the right face accompanied by the cupping method on the bleeding points. Results： The patient reported the complete disappearance of pain and could open mouth and eat normally. The face was normal and no triggering pain recurred after one-month follow-up. Conclusions： The fire needle combined with blood-letting therapy can cure the TN and might provide an alternative non-drug therapy for those patients who still suffered from TN after other medical treatments or whom that refused surgical treatment.

Diagnostic approach using endosonography guided fine needle aspiration for lymphadenopathy in primary sclerosing cholangitis

We report a case of primary sclerosing cholangitis (PSC) with benign lyphadenopathy which was diagnosed with endosonography guided fine needle aspiration (EUS-FNA). A 65-year-old woman was admitted to Jikei University Hospital with severe jaundice. Although endoscopic retrograde cholangiography and liver biopsy revealed the findings consistent with PSC, abdominal computed tomography revealed numerous large perihepatic lymph nodes with a maximum diameter of more than 3 cm. Therefore, EUS-FNA was done in order to exclude malignant lymphadenopathy, and adequate specimens obtained by EUS-FNA showed reactive hyperplasia of lymphnode. The patients were scheduled to undergo liver transplantation.

48 CASES OF ANXIETY SYNDROME TREATED BY MASSAGE

The anxiety syndrome is routinely treated with tranquilizing agents and psychological therapy. Although certain clinical effects can be obtained, some patients may experience an ever increasing listlessness and fatigue owing to the long-term dependence on the drugs, seriously interfering with their studies, work or daily life. In

Analysis of clinicopathological and immunohistochemical features of 15 cases with olfactory neuroblastoma

Objective:We studied the clinicopathological and immunohistochemical features of olfactory neuroblastoma(ONB).Methods:The clinic pathological data and immunohistochemical features of 15 cases with ONB were analyzed retrospectively,and the related literatures were reviewed.Results:The tumors were all located in the nasal cavity in 15 cases.According to Kadish's staging system,7 cases were in stage A,5 cases in stage B,and 3 cases in stage C.The morphological features showed small round or ovoid tumor cells divided into pieces or trabeculae by connective tissues which were rich in capillaries.The tumor cells had round or oval nuclei and fine chromatins and lack of cytoplasma.Flexner rosette and Homer-Wright rosette were found in some cases.Acidophilic fibrins were composed of cytoplasmic projection among tumor cells.All cases were positive for NSE,Syn,CgA,1 case was positive for Vimentin,2 cases were positive for S-100,while CKpan,LCA and HMB45 were all negative.Conclusion:ONB is a type of very rare malignant tumors,which could be diagnosed by pathology,and immunohistochemistry is helpful in the diagnosis and differential diagnosis.

The conditions for onset of beta oscillations in an extended subthalamic nucleus-globus pallidus network

The persistence of beta oscillations generated in the basal ganglia is typical pathological characteristic of Parkin-son's disease.In this paper,we construct a new network model,which is mainly composed of the subthalamic nu-cleus and the globus pallidus.Based on theory analysis,we obtained the beta shock conditions in the proposed model.It is shown that numerical simulations are in good agreement with analytical results.At last,the effects of cortex and striatum inputs on the generation of oscillations are also discussed.We hope that the obtained results may find applications to treatment of Parkinson’s disease and study of neural oscillations produced in other parts of the brain neural network.

Case Report of Three Patients with Wei-flaccidity Syndrome Cured by Acupuncture-moxibustion Therapy

Acupuncture-moxibustion therapy has an advantage in treating Wei-flaccidity syndrome resulted from peripheral nerve injuries. We have adopted acupuncture and moxibustion to treat 3 patients with Wei-flaccidity syndrome in clinical practice and now reports as follows.

Case Report:Pancreatic somatostatinoma with obscure inhibitory syndrome and mixed pathological pattern

Somatostatinoma is a very rare neuroendocrine tumor that originates from D cells and accounts for less than 1% of all gastrointestinal endocrine tumors. The duodenum is the most frequent site for this tumor, followed by the pancreas. We here describe a 46-year-old Chinese woman who developed pancreatic somatostatinoma presenting with the characteristic "inhibitory" syndrome, but the symptoms were obscure and seemingly uncorrelated. This case is also unique for its large tumor size and mixed pathological pattern. Distal pancreatectomy was performed, and the patient has remained well since operation. As the syndromes of somatostatinoma may be obscure and atypical, clinicians should review all clinical findings to obtain an accurate diagnosis. Aggressive surgery is preferred to improve the survival.