Animals ; Humans ; Lymph Nodes ; pathology ; Lymphangiogenesis ; physiology ; Lymphatic Metastasis ; Lymphatic Vessels ; metabolism ; pathology ; Neoplasms ; metabolism ; pathology ; Vascular Endothelial Growth Factor C ; metabolism ; physiology ; Vascular Endothelial Growth Factor D ; metabolism ; physiology

Objective To investigate the clinical heterogeneity of Parkinson's disease in the early stages.Methods Clinical data of demographic,motor phenotype,disease progression,cognitive,mood,autonomic and hallucination variables were collected from 143 patients with PD in the early stages.The patients' subtypes were explored with statistical cluster analysis of the clinical data.Results The analysis indicated four main subtypes:1.the younger-onset subtype(n=40);2.The tremor dominant subtype(n=57);3.the non-tremor dominant subtype with fast progression(n=17);4.The non-tremor dominant subtype with mild depression(n=29).Age at onset,posture-instability scores,the ratio of tremor scores to non-tremor scores,rate of progression and apathy scores all differentiated patients of respective subgroups.Conclusion The patients with early Parkinson's disease have marked heterogeneity in the clinical phenotype.

Objective To observe the effect of H shaped decalcified bone grafting on spinal fusion and anti conglutination by posterior approach and to evaluate its values in the application in spinal posterior approach surgery. Methods Total laminectomy was performed on 23 cases of severe spinal stenosis and 31 cases of intraspinal tumor for decompression. Thorough decompression of the nerve roots was performed on the former following total laminectomy while exploration and excision of the neoplasm were done on the latter. Then, H shaped decalcified bone grafts were inlaid between spinous processes and transverse processes to cover the lamina defection and overlap the adjacent segments in all cases. At last, the spinal internal fixation or plaster external fixation were used to stabilize vertebral segments according to the economic status of patients. The average time of follow up was 21 months (18～31 months). Results All patients got successful segmental spinal fusion within 8 months. Clinical symptoms were obviously alleviated in 43 cases at the end of follow up but symptoms recurred 12 months after operation in other 11 cases(all were tumor patients). Conclusion H shaped decalcified bone graft is valuable in spinal fusion and anti conglutination in spinal posterior approach surgery.

Objective To explore the imaging typing of skull eosinophilic granuloma( SEG) in children,and the clinical significance of this typing system was determined. Methods The clinical and radiological data of 32 cases of SEG confirmed by pathology in the past six years were retrospectively reviewed. According to the imaging findings,which included the size and shape of the granuloma,and the degree of skull destruction,SEGs were divided into four types:typeⅠ( subtle granumoma) ,typeⅡ( exteriorly convex granuloma) ,typeⅢ( biconvex granuloma) and typeⅣ(multiple granulomas and destructions). The imaging features of different types of SEG were analyzed,and the signif-icance of imaging typing was explored combining with the clinical manifestations,treatment programs and prognosis. Results Three cases (9. 4%) were included in typeⅠ,in which,the granuloma was not obvious and the skull destruction was confined in the diploe and outer plate. In type Ⅱ (21 cases,65. 6%),the imaging features included an obvious exteriorly convex mass and complete skull destruction of in-side and outside panels. Granuloma remove and destructed skull repair were performed in all cases,in which 15 were followed up and no re-currence was found. The imaging features of type Ⅲ (5 cases,15. 6%) were biconvex mass which broke through the inner plate and op-pressed the dura and cerebral parenchyma. Therapy program included not only surgical excision of the lesion but also repair of skull and dura. Three cases were followed up and no recurrence was found. Type Ⅳ (3 cases,9. 4%) showed multiple skull destructions and granulomas of various sizes. Chemotherapy and surgery treatment,poor prognosis and ease recurrence were characterized by this type. Conclusion we put forward a imaging typing method for SEGs. This typing system is helpful in guiding clinical protocols and prognosis of SEGs in children.

Objective To investigate the correlation rs2272087 polymorphism of STATS gene and asthma.Methods The polymerase chain reaction PCR- SBT technique was used to determine rs2272087 polymorphism in asthma and control group.Results The genotype of AA,AG and GG of rs2272087 were 0.600,0.412 and 0.167 in asthma group,and 0.430,0.200,0.367 in control group,respectively.The frequency of allele A and G was 0.903 and 0.344 in asthma group,and 0.656,0.970 in control group,respectively.There was significant difference in two groups(x2 =9.40,P ＜0.01 ;x2 =11.58,P ＜0.01 ).Conclusions The rs2272087 polymorphism of STAT5 gene may be an important candidate gene for asthma.

Objective To compare the ability of Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) in screening cognitive impairment in early stage of Parkinscn disease (PD). Methods The cognitive function of 101 patients with Parkinson disease (Hohen-Yahr stage 1-3) was assessed with MMSE. Ninety-six patients defined as having a normal age- and education-adjusted MMSE score were assessed subsequently with MoCA. The 96 patients were divided into two groups according to cut-off points of 26 of MoCA. The performance of cognitive domain was compared between PD-MCI group (MoCA <26) and control group (MoCA≥26). Results Mean MMSE and MoCA scores (standard deviation) were 27.17 (2.69) and 22.60(4.42) , respectively. 75% of the patients with normal MMSE scores had cognitive impairment according to their MoCA score. The PD-MCI group had lower scores in numerous cognitive domains (visuospatial and executive abilities, naming, attention,language, ab-straction, delayed memory) compared with control group (PD-MCI group: 3.11±1.40,2.56±0.69,5.07±1.05, 1.69±0.85,1.08±0.84, 1.08±1.31 ;Control group:4.75±0.61,2.92±0.28,5.88±0.45,2.46±0.66, 1.92±0.28,3.50±0.78, P<0.05). Predictors of cognitive impairment on the MoCA using univariate analyses were gender, age, education, Hoehn-Yabr stage, Unified Parkinscn Disease Rating Scale, depression severity (HAMD) and hallucination (r was-0.205,-0.209,0.263,-0.352,-0.225,-0.293 and-0.218, respectively). Condusions The MoCA is a more sensitive screening than the MMSE for cognitive impairment in early stage of PD.

Objective To assess cognitive impairment of patients with idiopathic Parkinson's disease(PD)of different clinical subgroups. Methods The cluster analysis approach was used to classify PD patients on the basis of their clinical features, and then compare their cognitive function according their Montreal Cognitive Assessment (MoCA)score. Results One-hundred and six patients were divided into 5 groups by means of cluster analysis:A. young-onset(n = 35), B. rapid disease progression(n = 6); C. tremor dominant(n = 36), D. haplo-non-tremor dominant(n =18),E. non-tremor dominant with depression(n = 11). The MoCA score and proportion of abnormal scores differed among the 5 groups significantly,especially between the subgroup E(19.00 ±5.47)and the subgroup A(23. 66 ± 3.51)(P ＜ 0. 05), the former was more seriously impaired in clock drawing task(1.73 ± 1. 01 vs.2. 66 ±0. 59 ,t = -2. 904,P =0. 013), alertness(0. 55 ±0. 52 vs. 0. 91 ±0. 28 ,t = -2. 241 ,P =0. 045),semantic fluency(0. 64 ±0. 51 vs. 0. 97 ±0. 17 ,t = -3. 429,P =0. 001)and orientation domains than the latter(4. 91 ± 1.38 vs. 5.80±0.47,t = -3.321,P =0.020). Conclusions The cognitive impairment in PD patients are common as well as heterogeneous.

Objective To investigate the risk factors of Parkinson's disease(PD)with mild cognitive impairment and mode of cerebral glucose metabolism. Methods One hundred and one non-dementia PD patients were assessed with Montreal Cognitive Assessment(MoCA)and divided into the PD with mild cognitive impairment (PD-MCI)group and the PD non-cognitive impairment(PD-NC)group. The demographic details, clinical features,Unified Pakinson's Disease Rating Scale(UPDRS), Hohen-Yahr rank and Hamilton Depression Scale(HAMD)were compared between the two groups. Patients in Hohen-Yahr stage 1 underwent positron emission tomography(PET)with 18F-fluorodeoxyglucose(18F-FDG)to show glucose metabolism. Results Seventy-seven(74. 3%)PD patients had mild cognitive impairment PD-MCI group had higher score in UPDRS 1st(mentation ,behavior and mood),2nd (activity of daily living)and 3rd(motor examination)subscale(2.48 ± 1.51,10. 71 ± 4. 88,22.31 ± 12.70)than PD-NC group(1.65 ± 1.29,8.15 ±2. 20,15.92 ±7.56,P ＜0.05)respectively. The FDG metabolism ratio of frontal cortex,parietal cortex and occipital cortex decreased more significantly in PD-MCI than in PD-NC(P ＜ 0.05).Conclusions The risk factors of mild cognitive impairment in PD include moter dysfunction, clinical stage and depression. The metabolic dysfunction of cortex may be the mechanism of mild cognitive impairment in PD.

Objective To evaluate the effect of continuous dopaminergic stimulation on the non-motor symptoms. Methods Fifty-eight patients with Parkinson's disease(PD) following motor fluctuation and non-motor symptom were enrolled in this study. The subjects were treated with levodopa/carbidopa and entacopone for eight weeks. The scores of NMSS, PD fatigue scale, HAMD and Pittsburgh Sleep Quality Index (PSQI) were compared between baseline and endpoint.Results The total scores of NMSS decreased significantly from baseline to endpoint (P<0.05). The scores of endpoint were significantly lower than those of baseline in the urinary, sexual function, depression/anxiety and sleep/fatigue subscale of NMSS; however, there was no significant difference between baseline and endpoint in the gastrointestinal, cardiovascular, hallucination/delusions, attention/memory subscales of NMSS. The scores of endpoint were significantly lower than those of baseline in HAMD, PD fatigue scale and PSQI.Conclusion The continuous dopaminergic stimulation treatment with levodopa/carbidopa and entacapone may improve some respects of non-motor symptom of PD.

Objective To investigate the relationship between fatigue and motor dysfunction in patients with Parkinson's disease(PD).Methods 139 PD patients were assessed with Fatigue Severe Scale(FSS) and divived into the fatigue group and non-fatigue group. The motor function, depression and cognitive function were assessed with Unified Pakinson's Disease Rating Scale(UPDRS), Hamilton Depression Scale and mini-mental state examination(MMSE) respectively. The Spearman's rank correlation coefficient was used to evaluate the correlation between fatigue and motor dysfunction.Results 70 patients had fatigue. The UPDRS motor subscale score of the fatigue group was significantly higher than the non-fatigue group (P<0.05). The UPDRS score of rigidity items and bradykinesia items of the fatigue group were significantly higher than those of the non-fatigue group(P<0.05), with no significant difference in UPSRS score of tremor items between the two groups (P>0.05). There was significant correlation between FSS score and UPDRS motor score (P<0.05). Conclusion Fatigue is one of the common symptoms of PD and correlates with motor dysfunction.