Kleptomania:Recent Advances in Symptoms,Etiology and Treatment

Kleptomania is a kind of uncontrollable impulse and behavior of stealing,and it is also a serious disease.At present,studies on pathological theft at home and abroad are not sufficient,and the understanding of the symptoms,etiology and treatment of this disease is very insufficient.This article focuses on the latest development of symptoms, etiology and treatment of kleptomania,providing a reference for people to further identify, treat and study the disease.

叶酸和甲钴胺治疗卒中患者髋关节骨折的随机对照试验

Context: Stroke increases the risk of subsequent hip fracture by 2 to 4 times. Hyperhomocysteinemia is a risk factor for both ischemic stroke and osteoporotic fractures in elderly men and women. Treatment with folate and mecobalamin (vita min B12) may improve hyperhomocysteinemia.Objective: To investigate whether trea tment with folate and vitamin B12 reduces the incidence of hip fractures in pati ents with hemiplegia following stroke.Design, Setting, and Patients: A double-b lind, randomized controlled study of 628 consecutive patients aged 65 years or o lder with residual hemiplegia at least 1 year following first ischemic stroke, w ho were recruited from a single Japanese hospital from April 1, 2000, to May 31, 2001. Patients were assigned to daily oral treatment with 5 mg of folate and 15 00 μg of mecobalamin,or double placebo; 559 completed the 2-year follow-up.Ma in Outcome Measure: Incidence of hip fractures in the 2 patient groups during th e 2-year follow-up. Results:At baseline, patients in both groups had high leve ls of plasma homocysteine and low levels of serum cobalamin and serum folate. Af ter 2 years, plasma homocysteine levels decreased by 38%in the treatment group and increased by 31%in the placebo group (P < .001). The number of hip fracture s per 1000 patient-years was 10 and 43 for the treatment and placebo groups, re spectively(P < .001). The adjusted relative risk, absolute risk reduction,and th e number needed to treat for hip fractures in the treatment vs placebo groups we re 0.20 (95%confidence interval [CI], 0.08-0.50), 7.1%(95%CI, 3.6%-10.8%) , and 14 (95%CI, 9-28), respectively. No significant adverse effects were repo rted. Conclusion: In this Japanese population with a high baseline fracture risk , combined treatment with folate and vitamin B12 is safe and effective in reduci ng the risk of a hip fracture in elderly patients following stroke.

甲钴胺对卒中患者未累及四肢的亚临床腕管综合征的改善作用

Our previous study showed that overuse of the nonparetichand and wrist of the nonparetic side following stroke result in significantly more abnormal on the no nparetic side than on the hemiparetic side in terms of electrophysiologic indice s of median nerve function. The purpose of this study was to evaluate the effect s of the orally administered mecobalamin, an analogue of vitamin B12, for carpal tunnel syndrome (CTS) in the nonparetic side in patients following stroke. In a randomized open label and prospective study of stroke patients, 67 received of 1500 μg mecobalamin daily for 2 years, and the remaining 68 (untreated group) d id not. At baseline, sensory nerve conduction velocity,motor nerve conduction ve locity, sensory nerve action potentials (SNAP) at the wrist, palm-to-wrist dis tal sensory latency, palm-to-wrist SNAP, motor nerve conduction velocity compo und motor action potentials, and distal motor latency of median nerve were signi ficantly more abnormal on the nonparetic side than on the hemiparetic side or in controls.Before the treatment 21 patients (31%) of untreated and 20 patients ( 30%) of treated group met electrophysiologic criteriafor CTS. Sensory impairmen t of the nonparetic side had lessened in the treated group. After 2 years, all e lectrophysiologic indices of nonparetic side were significantly improved in the treated group compared w ith those in the untreated group. The improvement from baseline of electrophysio logic parameters in sensory nerve in the treated group was greater than the impr ovement measured in motor nerve. There were no side effects. Oral mecobalamin tr eatment is a safe and potentially beneficial therapy for CTS in stroke patients.

干扰素β-1b对日本RRMS患者有效:一项随机多中心研究

Objective: To assess the efficacy of interferon beta-1b (IFNβ-1b) in Japane se patients with relapsing-remitting multiple sclerosis (RRMS). Background: The effects of IFNβin RRMS have been assessed in study populations comprised predo minantly of white patients. MS in Japanese patients is different from that in wh ite patients in that there are two different presentations classic MS (C-MS) an d optic-spinal MS (OS-MS)and chronic progressive forms are infrequent. Methods : A total of 205 Japanese patients with RRMS were randomized to receive 50 μg o r 250 μg (1.6 or 8.0 MIU) IFNβ-1b administered SC every other day for up to 2 years. The primary endpoint was annual relapse rate. Secondary endpoints includ ed further relapse-related and MRI outcome measures, as well as changes in Expa nded Disability Status Scale and Neurologic Rating Scale.Efficacy was assessed i n 188 patients, and safety was assessed in 192 patients. Supplemental ad hoc sub group analyses were also performed for patients with OS-MS and those with C-MS .Results: Annual relapse rates were 0.763 in the 250 μg group and 1.069 in the 50 μg group, a relative reduction of 28.6%(p = 0.047). Results for all seconda ry endpoints favored 250μg IFNβ-1b. Subgroup analyses suggested that the magn itude and direction of treatment effect in patients with OS-MS and C-MS was si milar, albeit not significant due to small sample size. Conclusions: Interferon beta-1b (IFNβ-1b) 250 μg significantly reduced relapse rates and change in M RI lesion area in Japanese patients with relapsing-remitting multiple sclerosis ,and seemed to be comparably effective in optic-spinal multiple sclerosis (MS) and classic MS. The response to treatment with IFNβ1b in Japanese patients with MS suggests that a common pathogenesis and underlying genetic characteristics a re shared with white patients.

肌萎缩性侧索硬化病肌肉疲劳过程中运动皮层兴奋性的变化

To further investigate the pathophysiology of amyotrophic lateral sclerosis (A LS), the silent period (SP) evoked by transcranial magnetic stimulation during a fatiguing muscle contraction was evaluated in 15 patients and in 15 healthy sub jects. Physiological lengthening of the SP duration was not observed in patients with disease duration of ≥2 years.Decreased intracortical inhibition, probably secondary to dysfunction of the inhibitory interneurons that modulate the corti comotoneuronal firing, appears in later stages of disease.Normal motor cortex ad aptation is impaired and cortical hyperexcitability might be unmasked during fatigue in ALS patient s with longer disease duration.

POEMS综合征患者的电生理学特征

Objective: Polyneuropathy, organomegaly, endocrinopathy,M protein, and skin ch anges (POEMS) syndrome is a rare cause of polyneuropathy. Although the polyneuro pathy component is essential for the diagnosis of the disease, the pattern of as sociated electrodiagnostic abnormalities has not been characterized in detail. T he purpose of this study was to elucidate the features of nerve conduction abnor malities in POEMS syndrome.Methods: We reviewed the medical records and nerve co nduction studies(NCS) of 12 consecutive patients with POEMS.Results: A total of 68 motor and 46 sensory nerves were examined.Compound muscle action potentials(C MAPs) and sensory nerve action potentials(SNAPs) were not elicited in lower limb s more frequently compared with in upper limbs (P < 0.05, in both motor and sens ory nerves), and the CMAP amplitude was more attenuated in lower limbs than in u pper limbs (P < 0.05). Abnormal conduction slowing was frequently observed in mo tor (95%) and sensory (76%) nerves. Distal motor latencies were abnormally pro longed in 75%of the motor nerves,and terminal latency indices were significant - ly higher in patients than in normal controls (P < 0.05). Conclusions: NCS in POEMS syndrome showed characteristic patterns, in which conduction abnormalities were more frequently and severely affected in the lower limbs, and more predomi nantly in the intermediate nerve segments than in the distal portions. Significa nce:The recognition of these characteristic patterns may be helpful for the earl y diagnosis of polyneuropathy in POEMS syndrome.

Management Recommendations on Sleep Disturbance o Patients with Parkinson's Disease

INTRODUCTION Sleep disturbance is one of the most common nonmotor symptoms in Parkinson's disease (PD).Sleep disturbance affects 40-98% of PD patients in the world. In China, the prevalence of PD patients with sleep disturbance ranges from 47.66% to 89.10%. Sleep disturbance usually has adverse impact on the quality of life of PD patients. Apossible pathogenesis of PD with sleep disturbance include thalamocortical pathway degeneration and changes of neurotransmitter systems. The etiology of sleep disturbance is multifactorial,involving degeneration of areas regulating sleep,sleep structure affected by drugs,sleep disturbance induced by drug,and sleep fragmentation by multiple factors.

缺血性卒中血流再通时代的脑细胞保护新策略

Acute ischemic stroke (AIS) treatment has been advanced by the development of recanalization therapies, especially endovascular thrombectomy. Thrombectomy has led to a better prognosis at 90 d not only in stroke patients because of large-vessel occlusion in the proximal anterior cerebral circulation, but also in those due to basilar-artery occlusion [1]. Thus, the number of eligible patients for revascularization will continue to increase.