Expression of Nucleotide-binding Oligomerization Domain Receptor Protein 3 in Patients with Alzheimer's Disease and Vascular Dementia and Related Factors / 中国康复理论与实践

@#Objective To explore the role of nucleotide-binding oligomerization domain receptor protein 3 (NLRP3) inflammasome in the pathogenesis of dementia. Methods 16 patients with with Alzheimer's disease (AD), 22 patients with vascular dementia (VD) and 20 healthy persons with similar age were detected the level of NLRP3 mRNA with RT-PCR in peripheral blood mononuclear cells January, 2014 to October, 2015. The serum level of interleukin (IL)-1βand IL-18 were detected with ELISA. The total number of white blood cells (WBC) and serum total calcium were collected. Single factor correlation analysis was performed between NLRP3mRNA and IL-1β, or IL-18, or WBC, or calcium concentration. Results The levels of NLRP3 mRNA ranged from high to low were as in AD group>VD group>the healthy group (q>11.48, P<0.05). The serum level of IL-1βwas higher in AD group than in the the healthy group (q=16.74, P<0.05), but not significantly different between VD group and the healthy group, nor between VD group and AD group (P<0.05). There was no signifi-cant difference about IL-18 among AD group, VD group and the healthy group (P<0.05). NLRP3 mRNA was positively correlated with the serum levels of IL-1β(r=0.64) and calcium (r=0.58) in AD group. There was no correlation between NLRP3 mRNA and IL-18 or WBC (P<0.05). Conclusion The expression of NLRP3 inflammasome may be related with the pathogenesis of AD, but little impact on the pathogene-sis of VD.

Apolipoprotein-E Gene Polymorphism in Patients with Alzheimer's Disease, Vascular Dementia or Mild Cognitive Impairment / 中国康复理论与实践

@#ObjectiveTo explore the Apolipoprotein-E （ApoE） gene polymorphism in patients with Alzheimer's disease （AD）, vascular dementia (VD) or mild cognitive impairment (MCI). MethodsPeripheral blood was taken from patient with AD, VD or MCI to determine the ApoE genotypes. ResultsThe most of the patients were ε3/ε3 genotype, while the ε2/ε2 and ε4/ε4 could not be detected. ε3/ε4 genotype （P=0.001） and ApoE ε4 allele （P=0.013） was more frequent in AD than in MCI. ApoE ε4 was more frequent in VD than in MCI （P=0.044）. ConclusionApoE ε4 allele is a risk factor in AD, and may be associated with VD and MCI.

Anestesia para intervenção cirúrgica endovascular na aorta abdominal: [revisão] / Anestesia para intervención quirúrgica endovascular en la aorta abdominal: [revisión] / Anesthesia for endovascular surgery of the abdominal aorta: [review]

JUSTIFICATIVA E OBJETIVOS: O procedimento endovascular para correção de aneurisma de aorta é menos invasivo que o convencional, além de apresentar outras vantagens, como ausência de incisão abdominal, ausência de pinçamento da aorta e menor tempo de recuperação pós-operatória. Por se tratar de procedimento cirúrgico relativamente novo e apresentar uma série de alterações que devem ser conhecidas pelo anestesiologista foi realizado este trabalho com o objetivo de revisar os aspectos mais relevantes do procedimento endovascular e possibilitar manuseio anestésico mais adequado no perioperatório. CONTEÚDO: Apresentação sucinta da técnica cirúrgica para reparo de aneurismas via endovascular, as possíveis vantagens e desvantagens do procedimento, bem como as complicações potenciais. Além disso, foram abordados os cuidados perioperatórios que o procedimento exige e as técnicas anestésicas que podem ser utilizadas. CONCLUSÕES: O conhecimento das alterações provenientes do procedimento endovascular possibilita conduta anestésica mais adequada e melhora dos resultados perioperatórios nesses pacientes.

BACKGROUND AND OBJECTIVES: Endovascular surgery for aneurism of the aorta is less invasive than the conventional procedure besides other advantages such as the absence of abdominal incision, absence of ligature of the aorta, and reduced postoperative recovery time. Since it is a relatively new procedure and to presenting a series of changes that should be known by the anesthesiologist, the objective of this report was to review the most relevant aspects of endovascular surgery, allowing more adequate perioperative anesthetic management. CONTENTS: A brief description of the technique of endovascular aneurism repair, possible vantages and disadvantages of its use, as well as potential complications are discussed. CONCLUSIONS: Knowledge of the changes secondary to the endovascular procedure allows a more adequate anesthetic conduct and improves the postoperative results in those patients.

JUSTIFICATIVA Y OBJETIVOS: El procedimiento endovascular para la corrección del aneurisma de aorta es menos invasivo que el convencional, además de presentar otras ventajas como la ausencia de incisión abdominal, ausencia de pinzamiento de la aorta y un menor tiempo de recuperación postoperatoria. Por tratarse de un procedimiento quirúrgico relativamente nuevo y por presentar una serie de alteraciones que deben ser conocidas por el anestesiólogo, se realizó este trabajo con el objetivo de revisar los aspectos más relevantes del procedimiento endovascular y posibilitar el manejo anestésico más adecuado en el perioperatorio. CONTENIDO: Sencilla presentación de la técnica quirúrgica para la cura de aneurismas vía endovascular, las posibles ventajas y desventajas del procedimiento, como también las complicaciones potenciales. Además de eso, se abordaron los cuidados perioperatorios que el procedimiento exige y las técnicas anestésicas que pueden ser utilizadas. CONCLUSIONES: El conocimiento de las alteraciones provenientes del procedimiento endovascular posibilita una conducta anestésica más adecuada y la mejora de los resultados perioperatorios en esos pacientes.

Anestesia para cesariana em gestante com hipoplasia de aorta distal: relato de caso / Anesthesia for cesarean section on a pregnant woman with hypoplasia of the distal aorta: case report

JUSTIFICATIVA E OBJETIVOS: Anomalias vasculares maternas, potencialmente graves para o feto, podem colocar em risco a perfusão uterina, suscitando cuidados ainda maiores por parte da equipe anestésica. O objetivo deste relato foi mostrar a conduta anestésica para operação cesariana em uma gestante com hipoplasia de aorta distal, logo abaixo da emergência das artérias renais, com estenose da artéria renal e ausência de artérias ilíacas. RELATO DO CASO: Paciente de 30 anos, 54 kg, na segunda gestação com uma cesariana anterior sem intercorrências. Durante a realização de ecografia gestacional na 12ª semana observou-se interrupção da aorta logo abaixo da saída das artérias renais. A paciente foi encaminhada para a realização de cineangiocoronariografia que mostrou hipoplasia da aorta distal abaixo das artérias renais, com ausência das artérias ilíacas. Durante a investigação clínica a paciente mostrou-se assintomática, com exceção de hipertensão arterial e claudicação aos grandes esforços. A paciente foi submetida à anestesia peridural contínua, com titulação da dose anestésica necessária à realização da cesariana. Inicialmente foram injetados 50 mg de bupivacaína a 0,5 por cento sem vasoconstritor e 10 µg de sufentanil. Quinze minutos após, a anestesia foi complementada com mais 25 mg de bupivacaína a 0,5 por cento, o que foi suficiente para atingir adequado nível de bloqueio. A cesariana transcorreu sem intercorrências e a criança nasceu em boas condições clínicas. CONCLUSÕES: O uso de anestesia peridural contínua com doses fracionadas demonstrou ser uma técnica anestésica segura para a realização desse procedimento por reduzir os riscos de hipotensão arterial materna inerente ao bloqueio espinal e também por minimizar a transferência placentária de fármacos, que ocorrem quando do emprego da anestesia geral. A titulação de fármacos através do cateter peridural possibilitou atingir nível anestésico adequado à realização do ato cirúrgico.

BACKGROUND AND OBJECTIVES: Maternal vascular anomalies, potentially severe for the fetus, can jeopardize uterine perfusion, which demands more caution by the anesthesiology team. The objective of this report was to demonstrate the anesthetic conduct for a cesarean section on a pregnant woman with hipoplasia of the distal aorta, just below the renal arteries, with stenosis of the renal artery and absence of the iliac arteries. CASE REPORT: This is a 30-year old patient, weighing 54 kg, on her second pregnancy, with a history of an uncomplicated cesarean section. During the gestational echocardiography on the 12th week, it was observed an interruption of the distal aorta, just below the renal arteries. The patient was referred for coronary angiography, which demonstrated hypoplasia of the distal aorta, just below the renal arteries, and absence of the iliac arteries. During the clinical investigation, the patient remained asymptomatic, except for hypertension and claudication during great efforts. She underwent continuous epidural anesthesia and the dose of the anesthetic was titrated as needed for the cesarean section. Initially, 50 mg of 0.5 percent bupivacaine without vasoconstrictor and 10 µg of sufentanil were administered. After 15 minutes, anesthesia was complemented with 25 mg of 0.5 percent bupivacaine, which was enough to achieve an adequate level of blockade. The cesarean section was performed without intercurrences, and the fetus was born in good clinical conditions. CONCLUSION: The use of continuous epidural block in fractionated doses demonstrated to be a safe anesthetic technique for this procedure because it reduces the risks of maternal hypotension, inherent to the spinal block, and also minimized the placentary transference of drugs, which is the case with general anesthesia. Titration of drugs through the epidural catheter allowed reaching an adequate anesthetic level for this type of surgery.

JUSTIFICATIVA Y OBJETIVOS: Anomalías vasculares maternas, potencialmente graves para el feto, pueden colocar en riesgo la perfusión uterina, suscitando cuidados mucho más puntuales por parte del equipo anestésico. El objetivo de este relato fue mostrar la conducta anestésica para operación en cesárea en una embarazada con hipoplasia de aorta distal, bien debajo de la emergencia de las arterias renales, con estenosis de la arteria renal y falta de arterias ilíacas. RELATO DEL CASO: Paciente de 30 años, 54 kg, en el 2° embarazo con una cesárea anterior sin intercurrencias. Durante la realización de ecografía de gestación en la 12ª semana se observó una interrupción de la aorta bien debajo de la salida de las arterias renales. A la paciente se le realizó cineangiocoronariografía que mostró hipoplasia de la aorta distal por debajo de las arterias renales, con ausencia de las arterias ilíacas. Durante la investigación clínica la paciente se mostró asintomática, con excepción de hipertensión arterial y claudicación a los grandes esfuerzos. La paciente fue sometida a la anestesia peridural continua, con titulación de la dosis anestésica necesaria para la realización de la cesárea. Inicialmente se inyectaron 50 mg de bupivacaína a 0,5 por ciento sin vasoconstrictor y 10 µg de sufentanil. Quince minutos después, la anestesia fue complementada con 25 mg más de bupivacaína a 0,5 por ciento, lo que fue suficiente para alcanzar un adecuado nivel de bloqueo. La cesárea transcurrió sin intercurrencias y el niño nació en buenas condiciones clínicas. CONCLUSIONES: El uso de anestesia peridural continua con dosis fraccionadas demostró ser una técnica anestésica segura para la realización de este procedimiento por reducir los riesgos de hipotensión arterial materna inherente al bloqueo espinal y también por minimizar la transferencia placentaria de fármacos que ocurren cuando se usa la anestesia general. La titulación de fármacos a través del catéter...

Effect of Acupuncture and Acupoint Injection on Dementia in Elder / 中国康复理论与实践

@#Objective To observe the effect of acupuncture and acupoint injection on dementia in elder.Methods 38 old dementia patients were divided into senile dementia(Alzheimer's disease,17 cases)and vascular dementia(21 cases).They were treated with acupuncture and acupoint injection with Piracetam.Results 7 cases improved in senile dementia patients,while 2 cases were excellent,7 cases were good,9 cases improved in vascular dementia patients.Conclusion Acupuncture and acupoint injection with Piracetam is more effective on senile dementia than vascular dementia.

Thyroid Hormone and Senile Dementia (review) / 中国康复理论与实践

@#With the body senescing,the endocrine function decreased.In the recent more than ten years,a relationship between pituitary-thyroid axis dysfunction and senile psychosis has attracted increasing attention.Thyroxin is thought to be closely related with the cognitive dysfunction and senile dementia.

Study of Semantic Priming Effect in Patients with Brain Injury / 中国康复理论与实践

@# Objective To investigate the changes of the semantic priming effect in patients with brain injury.Methods Eight patients with Alzheimer's disease(AD),fifteen patients with vascular dementia(VD),seventeen patients with traumatic brain injury (TBI),twenty four healthy young subjects,and seventeen elderly healthy subjects as normal controls were estimated by Mini-Mental State Examination(MMSE),clinical memory scale,and process dissociation procedure(PDP) tasks.The data of all subjects were analyzed.Results The patients in the AD group had lower recollection and automatic scores than those in the young and elderly control groups in free association task(P<0.05～0.001).The recollection scores in the VD and TBI groups decreased significantly when compared with that in the young and elderly control groups in free association tasks(P<0.001),whereas the automatic scores had no significant difference among four groups(P>0.05).Conclusion AD patients exhibited impaired explicit memory and semantic priming effect,but retain normal perceptual priming effect;VD and TBI patients showed impaired explicit memory,but retained normal semantic priming effect.

Prevalence of Dementia in the Elderly Residents of a Rural Community in Korea / 신경정신의학

The authors investigated the prevalence and risk factors of dementia among 1,674 elderly residents in Yonchon county of Kyonggi-do, a rural area of Korea who were above 65 years of age, in 1993. The primary screening was done with MMSE-K(Korean version of Mini-mental State Examination), and the final diagnoses of dementia for 436 subjects were made by NIHCDS-ADRDA criteria. The prevalence of total dementia was 9.5%, and it increased with advancing age. particularly, it rapidly increased in the elderly above 75 years of age. The prevalence of dementia in female as a whole was higher than in male, but this was not shown in each age group. The prevalences of Alzheimer's disease and vascular dementia were 4.5% and 2.5%, respectively, Assessing the degree of dementia with DSM-III-R criteria, the prevalence of moderate and severe dementia was 3.3%. Our result showed the similar finding to the prevalence of dementia in western countries, but was different from those of the previous studies in other Asian' countries, China and Japan.

The application of measurement of the width of pars compacta of substantia nigra in differential diagnosis on Parkinson's disease and vascular parkinsonism on MRI / 临床神经病学杂志

Objective To evaluate the value of measurement of the width of pars compacta of substantia nigra(SNc) and SNc's ratio to midbrain diameter in diagnosing Parkinson's disease(PD) and differentiating PD from vascular parkinsonism(VP) on routine MRI.Methods The width of SNc, midbrain diameter, and SNc's ratio to midbrain diameter were measured in 60 patients with PD (38 patients with Hoehn-Yahr stage Ⅰ～Ⅱ, 14 patients with Hoehn-Yahr stage Ⅲ, and 8 patients with Hoehn-Yahr stage Ⅳ), 60 patients with VP (26 patients with Hoehn-Yahr stage Ⅰ～Ⅱ, 20 patients with Hoehn-Yahr stage Ⅲ, and 14 patients with Hoehn-Yahr stage Ⅳ), and 60 age-matched heathly control subjects by means of routine axial T 2-weighted MRI. The results of measurement were analyzed and compared.Results Significant reduction was found in the width of SNc and SNc's ratio to midbrain diameter in PD compared those in VP and control subjects(P