Role of Oxalobacter formigenes in preventing calcium oxalate kidney stones

Objective To screen Oxalobacter formigenes (OxF) from fresh feces of healthy adults, and study its effect on the the prevention of calcium oxalate kidney stones. Methods OxF was screened and cultured from fresh feces of healthy adults. The rat model of calcium oxalate stone was established by esophageal gavage of 0.8% of ethylene glycol. Rats were divided into a control group and four groups of rats with ethylene glycol-induced calcium oxalate kidney stones according to random number table. Three groups were treated with 106 CFU, 107 CFU, 108 CFU viable OxF every day, respectively, for 4 weeks. The blood and 24-hour urine samples were collected to detect the serum creatinine, urea nitrogen, serum and urine calcium, phosphorus, magnesium and urine oxalate every week. At the end of the 4th week, the rats were sacrificed and the kidney tissues were stained with HE and Yasue. The deposition and content of calcium oxalate crystals were observed under a light microscope. Results The bacteria strain isolated from fresh feces of healthy adults was 100% as same as the known ATCC35274 bacteria strain, which means the strain screened is OxF. Among the 5 groups, there were no significant differences in body weight, Scr, BUN, serum calcium, blood magnesium, blood phosphorus, urinary magnesium and urinary phosphorus. The 24-hour urinary calcium excretion in the model group was significantly lower than that of the control group (P＜0.05). After intervention with OxF solution, the 24-hour urinary calcium excretion in the 108 CFU OxF group was significantly higher than that in the model group (P＜0.05), while there was no significant difference between the other intervention groups and the model. The oxalic acid excretion of 106 CFU OxF group and 107 CFU OxF group was lower than that of the model, but the difference did not reach statistical significance (P＞0.05). The 24 h oxalic acid excretion in the 108 CFU OxF group was significantly lower than that of the model at the end of first week (P＜0.05), and continued to decrease for the next 3 weeks. After 4 weeks of intervention, no crystal formation was observed in the control group under the deflection microscope, but a large amount of calcium oxalate crystals were formed in the renal cortex and renal medulla. The crystals were piled up and connected to each other. Yasue staining coincided with the calcium oxalate crystal in the same part of the kidneys. Compared with the model, there was no significant change in the score of calcium oxalate crystal in the kidneys of 106 CFU OxF group and 107 CFU OxF group, while the score of calcium oxalate crystal in the kidneys of 108 CFU OxF group was significantly lower (P＜0.05). Conclusions OxF are successively screened from healthy adults. Daily administration of 108 CFU OxF can safely and effectively reduce the urinary oxalic acid excretion, prevent the formation of calcium oxalate crystals and inhibit the formation of stones in kidneys of rats.     

以发热为首要症状的巨细胞动脉炎一例报道

<正>患者,女性,78岁,汉族,因"发热1个月余"于2018年8月14日入四川大学华西医院治疗。入院前1个多月,患者出现无明显诱因发热,每日下午体温升高,服用解热镇痛药后可缓解。自诉体温大多波动在37～38℃之间,最高体温38.1℃,伴有轻度咳嗽,咳少量白色黏痰,有夜间出汗、心慌等不适症状。无胸闷、胸痛,无腹痛、腹泻,无尿频、尿急、尿痛,无全身关节疼痛等症状。半个月前于外院住院,多次查血常规均提示血象正常,但红细胞及血红蛋白进行性下降,红细胞沉降率(erythrocyte sedimentation rate,ESR)明显高于正常,给予抗感染、对症支持等治疗后患者病情无好转,进一步行胸部CT、骨髓     

McCune-Albright综合征患儿超说明书用药并文献复习

探讨甲羟孕酮、来曲唑和唑来膦酸超说明书用药的合理性。方法：1例6岁8个月男性患儿，出生时发现左臀部咖啡样色斑，4岁颅面部畸形，5岁时出现第二性征发育，同时出现骨龄超前，诊断为"McCune-Albright综合征"。入院后，相继给予甲羟孕酮片（4 mg bid po）+来曲唑片（1.25 mg qd po）+唑来膦酸注射液（3 mg once iv gtt）+碳酸钙片（250 mg qd po）和维生素AD滴剂（胶囊型）（1粒qdpo）治疗。结果：经过23 d的对症治疗后，患者一般情况及症状稳定，要求出院。结论：临床药师参与患者的药物治疗过程，对唑来膦酸和甲羟孕酮、来曲唑的超说明书用药有了进一步的认识，提高了药物的治疗水平。临床药师通过参与临床实践，协助医师参与患者的用药监护，提高药物治疗的安全性。     

Comparative efficacy of first-line ceritinib and crizotinib in advanced or metastatic anaplastic lymphoma kinase-positive non-small cell lung cancer: an adjusted indirect comparison with external controls

Objective: In the absence of head-to-head trials, this study indirectly compared progression free survival (PFS) and overall survival (OS) between ceritinib and crizotinib among patients with previously untreated advanced anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC).

Methods: A matching-adjusted indirect comparison method was implemented to adjust for cross-trial differences in patient characteristics between ASCEND-4 and PROFILE 1014 trials. Patient-level data from ASCEND-4 and published summary data from PROFILE 1014 were used. Patients in ASCEND-4 were reweighted to match average baseline characteristics (i.e. age, sex, race, tumor histology, ECOG score, smoking status, extent of disease, and presence of brain metastases) reported for PROFILE 1014 patients using propensity score weighting. PFS and OS were then compared between balanced populations.

Results: ASCEND-4 included more current smokers (8.0% vs 4.4%) and fewer patients under the age of 65 years (78.5% vs 84.0%) compared to PROFILE 1014. After matching, these and all other patient characteristics were balanced between the two trial populations. Compared to crizotinib, ceritinib was associated with a significantly longer PFS (hazard ratio [95% confidence interval] (HR [CI])?=?0.64 [0.47–0.87]; median PFS: 25.2 vs 10.8 months, log-rank p-value?=?0.003). OS did not differ significantly, with a HR of 0.82 [0.54–1.27] for ceritinib compared to crizotinib.

Conclusions: In the adjusted indirect comparison with external controls, the second generation ALK inhibitor, ceritinib, was associated with a significantly prolonged PFS compared to crizotinib as first-line treatment for ALK-positive NSCLC.     

术中超声在脊髓髓内室管膜瘤和星形细胞瘤外科治疗中的应用

目的探讨术中超声在脊髓髓内室管膜瘤和星形细胞瘤显微外科手术中的应用价值。方法回顾性分析2010年1月至2018年5月华中科技大学同济医学院附属同济医院神经外科收治的78例脊髓髓内室管膜瘤和34例脊髓髓内星形细胞瘤患者的临床资料。根据术中是否使用超声辅助,分别将室管膜瘤和星形细胞瘤患者分为超声组(前者44例,后者18例)和对照组(前者34例,后者16例)。对所有患者行门诊或电话随访,通过影像学复查和改良McCormick量表(MMS)分级评估肿瘤复发和脊髓功能恢复情况。分别比较室管膜瘤和星形细胞瘤两组患者的疗效,并评价术中超声对肿瘤完全切除率的评估准确率。结果两组室管膜瘤和星形细胞瘤患者的性别、年龄、首诊症状、MMS分级及肿瘤累及脊髓节段的差异均无统计学意义(均P>0.05),基线资料均基本一致。室管膜瘤的超声组和对照组患者肿瘤完全切除率[分别为97.7%(43/44)、91.2%(31/34)]、术后并发症发生率[分别为8.8%(3/44)、11.8%(4/34)]及术后3个月脊髓功能恢复良好率[分别为36.4%(16/44)、32.4%(11/34)]的差异均无统计学意义(均P>0.05)。超声组和对照组的星形细胞瘤患者术后并发症发生比例(分别为:0/18、2/16)和术后3个月脊髓功能恢复良好比例(分别为:3/18、2/16)的差异均无统计学意义(均P>0.05);但与对照组比较,超声组的肿瘤完全切除比例高[分别为16/18、9/16,P<0.05]、无进展生存期(PFS)长[中位PFS分别为84.0(67.5~100.5)个月、75.0(52.0~98.0)个月,P<0.05]。以增强MRI为标准,术中超声判断室管膜瘤和星形细胞瘤全切除的准确比率分别为97.7%(42/43)、14/16。结论术中超声有助于实时、准确地判断脊髓髓内室管膜瘤和星形细胞瘤的肿瘤切除程度,且对星形细胞瘤的应用价值较大。     

Subcutaneous granuloma caused by Kodamaea ohmeri in an immunocompromised patient in China

We present a case of subcutaneous granuloma caused by Kodamaea ohmeri and describe the histopathological characteristics and skin lesions caused by this pathogen. A 55-year-old woman, with a history of rheumatoid arthritis, presented with red, painless plaque on her forehead, persistent for 3 months; based on the histopathological and mycological findings and gene sequencing, the patient was diagnosed with subcutaneous granuloma caused by K. ohmeri. This report highlights that early identification and diagnosis and optimal regimens are vital in the management of this intractable infection.     

Revisiting vascular and venous drainage of lateral arm flap from anatomy

European Journal of Orthopaedic Surgery & Traumatology -     

Insights into major facilitator superfamily domain-containing protein-2a (Mfsd2a) in physiology and pathophysiology. What do we know so far?

Major facilitator superfamily domain-containing protein-2a (Mfsd2a) which was considered as an orphan transporter has recently gained attention for its regulatory role in the maintenance of proper functioning of the blood–brain barrier. Besides the major role of Mfsd2a in maintaining the barrier function, increasing evidence has emerged with regard to the contributions of Mfsd2a to various biological processes such as transport, cell fusion, cell cycle, inflammation and regeneration, managing tumor growth, functioning of other organs with barrier functions or responses to injury. The purpose of this article is to review the different roles of Mfsd2a and its involvement in the physiological and pathophysiological processes primarily in the central nervous system and throughout the mammalian body under the lights of the current literature.     

原发性闭角型青光眼合并视网膜色素变性的临床特征分析

目的 分析原发性闭角型青光眼合并视网膜色素变性患者的临床特征。 方法 本研究纳入2013年4月至2017年4月于首都医科大学附属北京同仁医院眼科中心住院治疗的原发性闭角型青光眼(primary angle closure glaucoma ,PACG)合并视网膜色素变性(retinitis pigmentosa,RP)患者32例,和同期入院的不合并RP的PACG患者229例。根据青光眼类型将其分为4组,急性闭角型青光眼合并RP组(acute angle closure glaucoma with retinitis pigmentosa, AACG-RP)12例、慢性闭角型青光眼合并RP组(chronic angle closure glaucoma with retinitis pigmentosa, CACG-RP)20例、急性闭角型青光眼不合并RP组(AACG-non RP)94例、慢性闭角型青光眼不合并RP组(CACG-non RP)135例,比较4组患者的发病年龄和眼轴长度等参数。 结果 患者平均发病年龄AACG-RP组(39.00±12.07)岁、CACG-RP组(43.85±12.79)岁、AACG-non RP组(66.44±9.40)岁、CACG-non RP组(63.95±10.42)岁,4组之间差异有统计学意义(F=47.70,P<0.05)。患者平均眼轴长度AACG-RP组(21.31±1.37)mm、CACG-RP组(22.33±1.09)mm、AACG-non RP组(22.31±1.03)mm、CACG-non RP组(22.47±1.01)mm,4组之间差异有统计学意义(F=19.09,P<0.05)。 结论 原发性闭角型青光眼患者合并视网膜色素变性患者中,急性闭角型青光眼患者较慢性闭角型青光眼患者发病更早,眼轴更短。原发性闭角型青光眼合并视网膜色素变性患者,尤其是急性闭角型青光眼合并视网膜色素变性患者较无视网膜色素变性者发病年龄更早,且眼轴更短。