Thymus and mediastinal node involvement in childhood langerhans cell histiocytosis: Long‐term follow‐up from the French national cohort

Background

Mediastinal involvement (MI) in Langerhans cell histiocytosis (LCH) has been rarely reported. Here, we describe the clinical, radiological, and biological presentation, and the outcome of childhood LCH with MI.

Method

From the French LCH register, which includes 1,423 patients aged less than 18 years, we retrieved the medical charts of patients with mediastinal enlargement detected on chest X‐rays.

Results

Thirty‐seven patients were retrieved, including 18 males; median age of diagnosis was 0.7 years, and median follow‐up time was 6.2 years. The prevalence of MI varied with the age at diagnosis, ranging from 7% below 1 year old to less than 1% at >5 years. Thirteen cases (35%) were diagnosed because of MI‐related symptoms, including respiratory distress (N = 4), superior venous cava syndrome (N = 2), and/or cough and polypnea (N = 10). CT scans performed in 32 cases at diagnosis showed tracheal compression (N = 5), cava thrombosis (N = 2), and/or calcification (N = 16). All patients presented multi‐system disease at LCH diagnosis, and 35/37 were initially treated with vinblastine and corticosteroids. Death occurred in five cases, due to MI (N = 1) or hematological refractory involvement (N = 4). The overall 5‐year survival was 87.1%, and immunodeficiency was not detected as a sequel.

Conclusions

MI in LCH mainly occurs in young children, and diagnosis was based on CT showing thymus enlargement and calcifications. Pediatr Blood Cancer 2013;60:1759–1765. © 2013 Wiley Periodicals, Inc.     

Serum hepatitis B surface antigen correlates with fibrosis and necroinflammation: A multicentre perspective in China

The kinetics of serum hepatitis B surface antigen (HBsAg) during the natural history of hepatitis B virus (HBV) infection has been studied, but the factors affecting them remain unclear. We aimed to investigate the factors affecting HBsAg titres, using data from multicentre, large‐sized clinical trials in China. The baseline data of 1795 patients in 3 multicentre trials were studied, and the patients were classified into 3 groups: hepatitis B early antigen (HBeAg)‐positive chronic HBV infection (n = 588), HBeAg‐positive chronic hepatitis B (n = 596), and HBeAg‐negative chronic hepatitis B (n = 611). HBsAg titres in the different phases were compared, and multiple linear progression analyses were performed to investigate the implicated factors. HBsAg titres varied significantly in different phases (P = .000), with the highest (4.60 log10 IU/mL [10%‐90% confidence interval: 3.52 log10 IU/mL‐4.99 log10 IU/mL]) in patients with HBeAg‐positive chronic HBV infection. In all phases, age and HBV DNA were correlated with serum HBsAg level. In HBeAg‐positive chronic hepatitis B patients, a negative correlation between HBsAg titres and fibrosis stage was observed. Alanine amonitransferase or necroinflammatory activity was also correlated with HBsAg titres in HBeAg‐negative chronic hepatitis B patients. In conclusion, decreased HBsAg titres may be associated with advancing fibrosis in HBeAg‐positive chronic hepatitis B patients or increased necroinflammation in those with HBeAg‐negative chronic hepatitis B. Our findings may help clinicians better understand the kinetics of HBsAg and provide useful insights into the management of this disease.     

Dosimetric implications of the addition of 18 fluorodeoxyglucose-positron emission tomography in CT-based radiotherapy planning for non-small-cell lung cancer

The aim of this study was to assess the impact of F-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) CT on radiotherapy planning parameters for patients treated curatively with radiotherapy for non-small-cell lung cancer (NSCLC). Five patients with stages I–III NSCLC underwent a diagnostic FDG-PET CT (dPET CT), planning FDG-PET CT (pPET CT) and a simulation CT (RTP CT). For each patient, three radiation oncologists delineated a gross tumour volume based on RTP CT alone, and fused with dPET CT and pPET CT. Standard expansions were used to generate PTVs, and a 3D conformal plan was created. Normal tissue doses were compared between plans. Coverage of pPET CT PTV by the plans based on RTP CT and dPET CT was assessed, and tumour control probabilities were calculated. Mean PTV was similar between RTP CT, dPET CT and pPET CT, although there were significant inter-observer differences in four patients. The plans, however, showed no significant differences in doses to lung, oesophagus, heart or spinal cord. The RTP CT plan and dPET CT plan significantly underdosed the pPET PTV in two patients with minimum doses ranging from 12 to 63% of prescribed dose. Coverage by the 95% isodose was suboptimal in these patients, but this did not translate into poorer tumour control probability. The effect of fused FDG-PET varied between observers. The addition of dPET and pPET did not significantly change the radiotherapy planning parameters. Although FDG-PET is of benefit in tumour delineation, its effect on normal tissue complication probability and tumour control probability cannot be predicted.     

The effect of casein phosphopeptide-amorphous calcium phosphate on erosive dentine wear

Background:  Erosive tooth wear is a growing concern in clinical dentistry. Our aims were to assess the effect of Tooth Mousse (TM) in managing erosive dentine wear in vitro .
Methods:  Opposing enamel and dentine specimens from 36 third molar teeth were worn under a load of 100 N for 75 000 cycles in electromechanical tooth wear machines. In experiment 1, TM was applied continuously at the wear interface and the mean dentine wear rate was compared with those of specimens subjected to continuous application of hydrochloric acid (HCl, pH 3.0) and deionized water (DW, pH 6.1) as lubricants. In experiment 2, specimens were subjected to TM application every 1600 cycles at both pH 3.0 and 6.1, and the mean dentine wear rates were compared with those of specimens worn with continuous application of HCl and DW lubricants.
Results:  Dentine wear was reduced significantly with continuous application of TM compared with HCl and DW lubricants. Specimens prepared with continuous TM application displayed smooth wear facets, whereas more pronounced microwear details were observed with HCl and DW lubricants.
Conclusions:  Both remineralization and lubrication seem to contribute to reduction in dentine wear associated with TM application, although lubrication appears to have a more pronounced effect.     

剖宫产术后晚期产后出血11例分析

1临床资料1991-01/2004-10我院发生剖宫产术后晚期产后出血7例,外院转入4例,患者年龄25~34(平均26.6)岁.初产妇8例,经产妇3例,均为子宫下段剖宫产.出血发生在产后8~35(18±6)d(产后2~3wk多见),表现为突然发生阴道出血,鲜红色,出血量500~2500(平均1000)mL.患者均有头晕、心慌,合并出血性休克者6例.B超检查10例提示子宫下段切口有暗区,1例提示有胎盘残留.本组11例均用宫缩剂和广谱抗生素治疗,出血多或伴有休克者予输血,最多者输血2500mL,1例在B超监测下行清宫术,刮出物经病理证实为胎盘胎膜残留,7例行子宫次全切除术,3例行全子宫切除术.行子…     

Trisomy 16鼠结肠和人先天性巨结肠蛋白基因产物9.5的表达

目的：研究Ｄｏｗｎ’ｓ 综合征动物模型ｔｒｉｓｏｍｙ １６ 结肠神经系发育和先天性巨结肠（ＨＤ） 病变肠管蛋白基因产物９－５（ｐｒｏｔｅｉｎ ｇｅｎｅ ｐｒｏｄｕｃｔ９ ．５ ,ＰＧＰ９－５） 的神经表达。方法：Ｔｒｉｓｏｍｙ １６ 鼠培育;细胞遗传学分析;Ｔｒｉｓｏｍｙ １６ 鼠结肠和ＨＤＰＧＰ９－５ 免疫组织化学。结果：（１）Ｔｒｉｓｏｍｙ １６ 鼠结肠神经系发育异常,肌间神经丛发育迟缓,粘膜下神经丛缺失,结肠末端有５ ｍｍ 的无神经节区,但结肠系膜神经发育良好;（２）ＨＤ狭窄段肠管ＰＧＰ９－５ 阳性神经纤维大量增生,神经节细胞缺如。结论：（１）Ｔｒｉｓｏｍｙ １６ 鼠具有稳定的遗传学特征,可能伴先天性巨结肠。（２） 由于ＨＤ 狭窄段肠管神经节细胞缺失,增生的ＰＧＰ９－５ 阳性神经纤维是肠道外源性神经的代偿,对其神经元的性质尚有待确定。（３）ＨＤ有遗传倾向     

转小鼠TNFα基因大鼠脑缺血时TNFα表达对小胶质细胞激活的影响

目的：观察转小鼠TNFα基因大鼠脑缺血再灌流不同时间TNFα表达的动态变化及其对小胶质细胞激活的影响。方法：采用线栓法制作大鼠大脑中动脉闭塞模型,用TNFα、整合素QM(OX42)免疫组化染色观察转小鼠TNFα基因大鼠未缺血脑组织及缺血1h再灌注3h、12h、24h、72h、7d时的TNFα表达及小胶质细胞激活状态。结果：转小鼠TNFα基因大鼠缺血1h再灌注3hTNFα表达较未缺血脑组织明显增加,并达峰值,缺血1h再灌注12～72h,TNFα表达仍较显著,但随时间的延长逐渐减少,再灌注7d时,TNFα表达接近缺血前水平。转小鼠TNFα基因大鼠脑组织小胶质细胞缺血1h再灌注3h小胶质细胞极显著地被激活,并达峰值;缺血1h再灌注12h、24h、72h、7d时脑组织小胶质细胞与未缺血脑组织比较显著被激活,但随时间的延长,小胶质细胞激活状态逐渐接近缺血前的水平。结论：脑缺血再灌注后TNFα表达的动态变化与小胶质细胞激活的动态变化完全一致,提示脑缺血再灌注后小胶质细胞的激活主要与TNFα的过度表达有关。