目的调查帕金森病（PD）患者中异动症及症状波动的发生率、分布情况以及影响因素。方法详细记录患者资料，并进行统一帕金森病评分量表（UPDRS）、Hoehn＆Yahn（H—Y）分级评分。根据UPDRS1V记录患者有无异动症及症状波动。结果122例患...目的调查帕金森病（PD）患者中异动症及症状波动的发生率、分布情况以及影响因素。方法详细记录患者资料，并进行统一帕金森病评分量表（UPDRS）、Hoehn＆Yahn（H—Y）分级评分。根据UPDRS1V记录患者有无异动症及症状波动。结果122例患者接受左旋多巴治疗，疗程至少6个月。其中15例（12．3％）合并异动症，41例（33．6％）合并症状波动。异动症的独立影响因素为：发病年龄（OR=0．907，P〈0．01）和左旋多巴总量（95％ CI 1．000～1．004，OR=1．002，P〈0．05）；症状波动的独立影响因素为：发病年龄（OR=0．922，P〈0．05），接受左旋多巴治疗的时间（OR=1．234，P〈0．05），左旋多巴总量（95％ CI 1．002—1．008，OR=1．005，P〈0．01）和H—Y分级（OR=1．869，P〈0．05）。结论本组患者异动症及症状波动的发生率均低于欧洲调查结果，每日左旋多巴总量是异动症及症状波动的独立影响因素。添加其他药物辅助治疗而减少左旋多巴用量，可以减少运动并发症的发生。展开更多
Objective To study the changes of prodynorphin （PDyn） gene expression and dopamine and cAMPregulated phosphoprotein of 32 kDa （DARPP-32） phosphorylation in rats with levodopa-induced dyskinesias （LID）, and to ex...Objective To study the changes of prodynorphin （PDyn） gene expression and dopamine and cAMPregulated phosphoprotein of 32 kDa （DARPP-32） phosphorylation in rats with levodopa-induced dyskinesias （LID）, and to explore the mechanism of over-activation in direct pathway mediated by dopamine D1 receptor. Methods Parkinson＇s disease （PD） rats were received levodopa （10 mg/kg, i.p.） for 28 d to get the LID rats. According to the behavior scale, LID rats were divided into mild （n=8） and severe （n=16） groups. On day 29, 8 rats in severe LID group were given an acute intraperitoneal injection of MK-801 （0.1 mg/kg） 15 min before levodopa treatment （MK-801 group, n=8）. The normal rats received same course and dosage of levodopa as the control group （n=8）. Hybridization in situ was used to measure the expression of PDyn mRNA in striatum. Protein and mRNA levels of total DARPP-32 and phospho-Thr-34 DARPP-32 level were measured by immunoblotting and RT-PCR, respectively. Results The levels of PDyn mRNA and phospho-Thr-34 DARPP-32 increased significantly in LID rats compared with control rats （P〈0.01）, and they also increased markedly in severe LID group compared with mild group （P〈0.01）. Conclusion Phospho-Thr-34 DARPP-32 level was increased in LID rats, which contributed to the over-activation of direct pathway mediated by dopamine D1 receptor.展开更多
目的分析健康人直立于不同厚度海绵垫时姿势特征的变化,探讨本体觉受到不同程度干扰时的姿势平衡改变。方法 30例健康人分别站立于坚硬平板和不同厚度的海绵垫,海绵厚度依次从1到5块,每块厚度4.7 cm。每种站立平面下,均睁眼和闭眼各站立...目的分析健康人直立于不同厚度海绵垫时姿势特征的变化,探讨本体觉受到不同程度干扰时的姿势平衡改变。方法 30例健康人分别站立于坚硬平板和不同厚度的海绵垫,海绵厚度依次从1到5块,每块厚度4.7 cm。每种站立平面下,均睁眼和闭眼各站立30 s。应用姿势描记仪记录人体直立时足底压力中心(center of pressure,COP)晃动的相关参数,包括总轨迹长、平均速度、单位面积轨迹长、外周面积、实效值面积、矩形面积。结果所有参数在睁眼和闭眼条件下均有随海绵垫厚度的增加而变化趋势(睁眼时 F 值为9.14～107.18,闭眼时 F 值为32.19～144.35,P 值均<0.0001),除单位面积轨迹长呈减少趋势外,其余参数均为增加趋势;对各参数在不同海绵垫间的差异进行比较,无统计学意义的情况有:①总轨迹长和速度:睁眼及闭眼时,4和5块之间;②单位面积轨迹长:睁眼时,0和1、1和3、2和3、3和4、4和5块之间;闭眼时,3和4、3和5、4和5块之间;③外周面积:睁眼时2和3、3和4、4和5块之间;闭眼时,3和4、3和5、4和5块之间;④实效值面积和矩形面积:睁眼时2和3、4和5块之间;闭眼时,3和4、3和5、4和5块之间。其余比较差异均有统计学意义(P<0.05)或极显著统计学意义(P<0.01)。结论在一定范围内,随着海绵垫厚度增加,直立其上的人体本体觉受到的干扰程度加剧,其姿势稳定性逐渐降低;应用海绵垫干扰本体觉同时,姿势描记仪记录的各参数中,COP 晃动的轨迹长度和平均速度是较适宜描述姿势平衡变化的指标;应用海绵垫对直立人体足底本体觉进行干扰时,应考虑海绵厚度对结果的影响,选择适宜的厚度,以提高其临床应用价值。展开更多
Objective： To observe the clinical effects in the treatment of post-stroke dysfunction of lower limb by puncturing Weizhong （BL 40）. Methods： One hundred and twenty patients were randomly divided into two groups,...Objective： To observe the clinical effects in the treatment of post-stroke dysfunction of lower limb by puncturing Weizhong （BL 40）. Methods： One hundred and twenty patients were randomly divided into two groups, 60 cases in each group. Both groups were treated by puncturing Weizhong （BL 40） plus functional rehabilitation training, once every day. Those in the observation group were treated by Shi Xue-min＇s needling technique, while others in the control group were treated with routine needling technique. The therapeutic effects were assessed by the scores of lower limb functions of Lovett scale of grading muscle strength （LSGMS） and short-form FugI-Meyer assessment （SFFMA）. Results： The instant and post-treatment effective rates in the observation group were 83.3% and 93.3%, versus 6.7% and 53.3% in the control group, indicating that the therapeutic effect was better in the observation group （P〈0.01）. The instant and post-treatment scores of Lovett muscle strength grading scale were better in the observation group than that in the control group （P〈0.05）. SFFMA score of lower limbs function was better in the observation group than that in the control group （P〈0.0s）. Conclusion： Different needling methods at Weizhong （BL 40） can produce different therapeutic effects in treating post-stroke dysfunction of lower limb, and Shi＇s needling technique has obvious instant effect and therapeutic function.展开更多
Objective：The aim of this study was to summarize recent studies on nondopaminergic options for the treatment of motor symptoms in Parkinson＇s disease （PD）.Data Sources：Papers in English published in PubMed,Cochra...Objective：The aim of this study was to summarize recent studies on nondopaminergic options for the treatment of motor symptoms in Parkinson＇s disease （PD）.Data Sources：Papers in English published in PubMed,Cochrane,and Ovid Nursing databases between January 1988 and November 2016 were searched using the following keywords：PD,nondopaminergic therapy,adenosine,glutamatergic,adrenergic,serotoninergic,histaminic,and iron chelator.We also reviewed the ongoing clinical trials in the website of clinicaltrials.gov.Study Selection：Articles related to the nondopaminergic treatment of motor symptoms in PD were selected for this review.Results：PD is conventionally treated with dopamine replacement strategies,which are effective in the early stages of PD.Long-term use oflevodopa could result in motor complications.Recent studies revealed that nondopaminergic systems such as adenosine,glutamatergic,adrenergic,serotoninergic,histaminic,and iron chelator pathways could include potential therapeutic targets for motor symptoms,including motor fluctuations,levodopa-induced dyskinesia,and gait disorders.Some nondopaminergic drugs,such as istradefylline and amantadine,are currently used clinically,while most such drugs are in preclinical testing stages.Transitioning of these agents into clinically beneficial strategies requires reliable evaluation since several agents have failed to show consistent results despite positive findings at the preclinical level.Conclusions：Targeting nondopaminergic transmission could improve some motor symptoms in PD,especially the discomfort ofdyskinesia.Although nondopaminergic treatments show great potential in PD treatment as an adjunct therapy to levodopa,further investigation is required to ensure their success.展开更多
Continuous dopaminergic stimulation（CDS）is a prominent therapeutic concept for the treatment of Parkinson＇s disease（PD）,which proposes that continuous brain dopamine-receptor stimulation,rather than intermittent ...Continuous dopaminergic stimulation（CDS）is a prominent therapeutic concept for the treatment of Parkinson＇s disease（PD）,which proposes that continuous brain dopamine-receptor stimulation,rather than intermittent doses of oral L-dopa,prevents or manages L-dopa-induced dyskinesias（LIDs）.In the normal situation,dopaminergic neurons in the substantia nigra pars compacta fire tonically to keep the dopamine receptor stimulation at a steady-state level.But when the dopaminergic pathway is impaired,the dopamine receptor stimulation becomes intermittent or pulsatile.This pulsatile stimulation causes a series of gene and protein changes in striatal neurons,leading to alterations in the firing patterns of basal ganglia neurons that result in LIDs.Studies in animal models and clinical trials of PD have shown that approaches providing CDS,currently including patches,extended-release formulations of L-dopa or dopamine agonists,continuous delivery of apomorphine and duodenal L-dopa infusion,are associated with a decreased risk of LIDs.In this review,we summarize both preclinical and clinical evidence for the five methods that may provide CDS in theory and compare the advantages and disadvantages of these methods.展开更多
文摘目的调查帕金森病（PD）患者中异动症及症状波动的发生率、分布情况以及影响因素。方法详细记录患者资料，并进行统一帕金森病评分量表（UPDRS）、Hoehn＆Yahn（H—Y）分级评分。根据UPDRS1V记录患者有无异动症及症状波动。结果122例患者接受左旋多巴治疗，疗程至少6个月。其中15例（12．3％）合并异动症，41例（33．6％）合并症状波动。异动症的独立影响因素为：发病年龄（OR=0．907，P〈0．01）和左旋多巴总量（95％ CI 1．000～1．004，OR=1．002，P〈0．05）；症状波动的独立影响因素为：发病年龄（OR=0．922，P〈0．05），接受左旋多巴治疗的时间（OR=1．234，P〈0．05），左旋多巴总量（95％ CI 1．002—1．008，OR=1．005，P〈0．01）和H—Y分级（OR=1．869，P〈0．05）。结论本组患者异动症及症状波动的发生率均低于欧洲调查结果，每日左旋多巴总量是异动症及症状波动的独立影响因素。添加其他药物辅助治疗而减少左旋多巴用量，可以减少运动并发症的发生。
文摘Objective To study the changes of prodynorphin （PDyn） gene expression and dopamine and cAMPregulated phosphoprotein of 32 kDa （DARPP-32） phosphorylation in rats with levodopa-induced dyskinesias （LID）, and to explore the mechanism of over-activation in direct pathway mediated by dopamine D1 receptor. Methods Parkinson＇s disease （PD） rats were received levodopa （10 mg/kg, i.p.） for 28 d to get the LID rats. According to the behavior scale, LID rats were divided into mild （n=8） and severe （n=16） groups. On day 29, 8 rats in severe LID group were given an acute intraperitoneal injection of MK-801 （0.1 mg/kg） 15 min before levodopa treatment （MK-801 group, n=8）. The normal rats received same course and dosage of levodopa as the control group （n=8）. Hybridization in situ was used to measure the expression of PDyn mRNA in striatum. Protein and mRNA levels of total DARPP-32 and phospho-Thr-34 DARPP-32 level were measured by immunoblotting and RT-PCR, respectively. Results The levels of PDyn mRNA and phospho-Thr-34 DARPP-32 increased significantly in LID rats compared with control rats （P〈0.01）, and they also increased markedly in severe LID group compared with mild group （P〈0.01）. Conclusion Phospho-Thr-34 DARPP-32 level was increased in LID rats, which contributed to the over-activation of direct pathway mediated by dopamine D1 receptor.
文摘目的分析健康人直立于不同厚度海绵垫时姿势特征的变化,探讨本体觉受到不同程度干扰时的姿势平衡改变。方法 30例健康人分别站立于坚硬平板和不同厚度的海绵垫,海绵厚度依次从1到5块,每块厚度4.7 cm。每种站立平面下,均睁眼和闭眼各站立30 s。应用姿势描记仪记录人体直立时足底压力中心(center of pressure,COP)晃动的相关参数,包括总轨迹长、平均速度、单位面积轨迹长、外周面积、实效值面积、矩形面积。结果所有参数在睁眼和闭眼条件下均有随海绵垫厚度的增加而变化趋势(睁眼时 F 值为9.14～107.18,闭眼时 F 值为32.19～144.35,P 值均<0.0001),除单位面积轨迹长呈减少趋势外,其余参数均为增加趋势;对各参数在不同海绵垫间的差异进行比较,无统计学意义的情况有:①总轨迹长和速度:睁眼及闭眼时,4和5块之间;②单位面积轨迹长:睁眼时,0和1、1和3、2和3、3和4、4和5块之间;闭眼时,3和4、3和5、4和5块之间;③外周面积:睁眼时2和3、3和4、4和5块之间;闭眼时,3和4、3和5、4和5块之间;④实效值面积和矩形面积:睁眼时2和3、4和5块之间;闭眼时,3和4、3和5、4和5块之间。其余比较差异均有统计学意义(P<0.05)或极显著统计学意义(P<0.01)。结论在一定范围内,随着海绵垫厚度增加,直立其上的人体本体觉受到的干扰程度加剧,其姿势稳定性逐渐降低;应用海绵垫干扰本体觉同时,姿势描记仪记录的各参数中,COP 晃动的轨迹长度和平均速度是较适宜描述姿势平衡变化的指标;应用海绵垫对直立人体足底本体觉进行干扰时,应考虑海绵厚度对结果的影响,选择适宜的厚度,以提高其临床应用价值。
基金supported by National Basic Research Program of China(973 Program,2006CB504504)Major Scientific and Technological Project of Tianjin Scientific and Technological Target Program(05YFGDSF02300)
文摘Objective： To observe the clinical effects in the treatment of post-stroke dysfunction of lower limb by puncturing Weizhong （BL 40）. Methods： One hundred and twenty patients were randomly divided into two groups, 60 cases in each group. Both groups were treated by puncturing Weizhong （BL 40） plus functional rehabilitation training, once every day. Those in the observation group were treated by Shi Xue-min＇s needling technique, while others in the control group were treated with routine needling technique. The therapeutic effects were assessed by the scores of lower limb functions of Lovett scale of grading muscle strength （LSGMS） and short-form FugI-Meyer assessment （SFFMA）. Results： The instant and post-treatment effective rates in the observation group were 83.3% and 93.3%, versus 6.7% and 53.3% in the control group, indicating that the therapeutic effect was better in the observation group （P〈0.01）. The instant and post-treatment scores of Lovett muscle strength grading scale were better in the observation group than that in the control group （P〈0.05）. SFFMA score of lower limbs function was better in the observation group than that in the control group （P〈0.0s）. Conclusion： Different needling methods at Weizhong （BL 40） can produce different therapeutic effects in treating post-stroke dysfunction of lower limb, and Shi＇s needling technique has obvious instant effect and therapeutic function.
基金This work was supported by grants from the National Natural Science Foundation of China （No. 81371407 and No. 81430022）.
文摘Objective：The aim of this study was to summarize recent studies on nondopaminergic options for the treatment of motor symptoms in Parkinson＇s disease （PD）.Data Sources：Papers in English published in PubMed,Cochrane,and Ovid Nursing databases between January 1988 and November 2016 were searched using the following keywords：PD,nondopaminergic therapy,adenosine,glutamatergic,adrenergic,serotoninergic,histaminic,and iron chelator.We also reviewed the ongoing clinical trials in the website of clinicaltrials.gov.Study Selection：Articles related to the nondopaminergic treatment of motor symptoms in PD were selected for this review.Results：PD is conventionally treated with dopamine replacement strategies,which are effective in the early stages of PD.Long-term use oflevodopa could result in motor complications.Recent studies revealed that nondopaminergic systems such as adenosine,glutamatergic,adrenergic,serotoninergic,histaminic,and iron chelator pathways could include potential therapeutic targets for motor symptoms,including motor fluctuations,levodopa-induced dyskinesia,and gait disorders.Some nondopaminergic drugs,such as istradefylline and amantadine,are currently used clinically,while most such drugs are in preclinical testing stages.Transitioning of these agents into clinically beneficial strategies requires reliable evaluation since several agents have failed to show consistent results despite positive findings at the preclinical level.Conclusions：Targeting nondopaminergic transmission could improve some motor symptoms in PD,especially the discomfort ofdyskinesia.Although nondopaminergic treatments show great potential in PD treatment as an adjunct therapy to levodopa,further investigation is required to ensure their success.
基金supported by a grant from the Science and Technology Bureau of Zhejiang Province, China (2011c14026)
文摘Continuous dopaminergic stimulation（CDS）is a prominent therapeutic concept for the treatment of Parkinson＇s disease（PD）,which proposes that continuous brain dopamine-receptor stimulation,rather than intermittent doses of oral L-dopa,prevents or manages L-dopa-induced dyskinesias（LIDs）.In the normal situation,dopaminergic neurons in the substantia nigra pars compacta fire tonically to keep the dopamine receptor stimulation at a steady-state level.But when the dopaminergic pathway is impaired,the dopamine receptor stimulation becomes intermittent or pulsatile.This pulsatile stimulation causes a series of gene and protein changes in striatal neurons,leading to alterations in the firing patterns of basal ganglia neurons that result in LIDs.Studies in animal models and clinical trials of PD have shown that approaches providing CDS,currently including patches,extended-release formulations of L-dopa or dopamine agonists,continuous delivery of apomorphine and duodenal L-dopa infusion,are associated with a decreased risk of LIDs.In this review,we summarize both preclinical and clinical evidence for the five methods that may provide CDS in theory and compare the advantages and disadvantages of these methods.
