颈部血管滤泡淋巴组织增生病的诊断与治疗

目的探讨颈部血管滤泡淋巴组织增生病（Castleman disease,CD）的临床表现及诊治。方法回顾性分析我院收治的2例颈部CD患者的临床资料,分析其临床表现、临床及病理分型、影像学特征和治疗方案。结果2例颈部CD发病年龄分别为24岁和29岁,均以单发无痛性颈部肿块就诊,无其他特殊临床症状。临床分型符合局限型CD,病理分型均符合透明血管型CD。2例颈部肿块均完整手术切除,分别随访1年和半年无复发。结论颈部CD常为局限性病变,以单发无痛性肿块缓慢增大为主要表现,常无其他特殊临床症状。常见发病部位为颈部淋巴结,病理分型几乎全部为透明血管型。完整肿块切除是治疗颈部CD的最佳治疗方法。     

骨代谢生化指标临床应用专家共识（2019）

骨代谢生化指标包括钙磷代谢调节指标、骨形成标志物、骨吸收标志物、激素与细胞因子。骨代谢生化指标分别来源于骨、软骨、软组织、皮肤、肝、肾、小肠、血液及内分泌腺体等,是由成骨细胞或破骨细胞分泌的酶和激素,以及骨基质的胶原蛋白代谢产物或非胶原蛋白。骨代谢生化指标可及时反映骨转换状态,灵敏度高、特异性强,用于骨质疏松诊断分型、预测骨折风险、抗骨质疏松治疗疗效评价,以及代谢性骨病的鉴别诊断。并且在骨质疏松流行病学、发病机制、骨质疏松药物的研究方面具有重要的临床意义。     

亚催眠剂量丙泊酚减少剖宫产术中恶心呕吐的随机对照研究

目的研究亚催眠剂量丙泊酚对剖宫产产妇术中恶心呕吐的作用。方法64例腰麻硬膜外联合麻醉下剖宫产患者随机分成对照组（A组）和丙泊酚组（B组）,在脐带结扎后至缝皮结束按照血浆靶控浓度1 μg/mL靶控丙泊酚,A组以脂肪乳代替丙泊酚。比较2组镇静深度、恶心呕吐程度、镇吐药剂量、升压药剂量、脉搏氧饱和度、术者及患者满意度、新生儿神经行为学评分(neonatal behavioral neurological assessment,NBNA)等。结果A组恶心呕吐发生率明显高于B组,差异有统计学意义（P＜0.05）;在脐带结扎后的10 min 2组镇静深度评分比较差异无统计学意义(P>0.05),20、30 min 2组比较差异有统计学意义（P＜0.05）;2组术中应用升压药物次数、血氧饱和度比较差异无统计学意义(P>0.05);术者与患者的满意度,B组与A组比较差异有统计学意义（P＜0.05）;2组新生儿Apgar评分及母乳喂养后2组新生儿NBNA比较差异无统计学意义(P>0.05)。结论亚催眠剂量丙泊酚(1 μg/mL)可有效降低剖宫产术中恶心呕吐发生率,术中呼吸循环稳定,且不影响术后母乳喂养。     

Abnormal Expression of the Imprinted Gene Phlda2 in Cloned Bovine Placenta

Cloning in mammals suffers from high rates of pregnancy losses associated with abnormal placentation, mainly placentomegaly, leading to fetal death. Placental growth is dependent on the regulated expression of many genes of which imprinted genes play a fundamental role. Among them, the Phlda2 gene is expressed from the maternal allele and acts to limit placental growth in mouse and human. Here we used Northern blots, quantitative RT-PCR and in situ hybridization to analyze the expression patterns of bovine PHLDA2 and to compare its expression levels in normal and somatic cell nuclear transfer (SCNT) placentas over a range of gestational stages. PHLDA2 is not expressed in extra-embryonic tissues before d32 of gestation but the level of expression increases throughout pregnancy until term in the placental villi collected from pregnancy obtained by artificial insemination (AI). At all stages of pregnancy, PHLDA2 mRNA are specifically localized in the trophoblast mononucleated cells contrasting with lack of expression in the binucleated cells and uterine tissues. In SCNT placentas, a similar pattern of expression was observed during early pregnancy. In contrast the level of expression is significantly reduced around d200 of gestation in the placental villi from pathological clones. The reduced expression of PHLDA2 was obvious particularly in the placental villi anchored within the uterine crypts with expression confined to the trophoblast of the chorionic plate. Altogether, these results highlight a similarity in expression patterns for PHLDA2 bovine and human where expression is localized to the trophoblast throughout pregnancy and parallels the continuous growth of the placenta. Moreover, the lack of expression in the fetal villi from oversized bovine cloned placenta is consistent with the function of PHLDA2 in restraining placental growth and underlines an aberrant expression of this gene after somatic cloning.     

Validity of radiographic measurement of interproximal bone loss

The aim of the present study was to compare radiographic assessment of interproximal bone loss using a loupe with a 0.1 mm calibrated grid and a computer-assisted analysis system (LMSRT). In 35 patients suffering from untreated advanced periodontal disease, 62 standardized radiographs were taken presurgically. The horizontal and vertical angulation difference of the central beam from the orthoradial projection was calculated for each radiograph. At the time of surgery, for 115 interproximal defects, the distances from the cementoenamel junction (CEJ) to alveolar crest (AC), and CEJ to bottom of the bony defect (BD) were measured. In all radiographs, the linear distances CEJ to AC, and CEJ to BD were assessed using a loupe and LMSRT. Comparison between radiographic and intrasurgical assessments was performed using paired t-tests. A stepwise multiple linear regression analysis was used to evaluate factors that influence the discrepancy between radiographic and intrasurgical measurements. Both analyzing techniques underestimated interproximal bone loss as compared with intrasurgical measurements (CEJ-AC: loupe: 0.86 ± 1.84 mm [p < 0.001]; LMSRT: 0.58 ± 1.86 mm [p < 0.005]; CEJ-BD: loupe: 1.22 ± 2.33 mm [p < 0.001]; LMSRT: 0.80 ± 2.09 mm [p < 0.001]). LMSRT underestimated interproximal bone loss significantly less than the loupe (p < 0.001). The difference between LMSRT and intrasurgical assessments was modulated by the factors of vertical and horizontal angulation difference and defect depth (p < 0.1). Orthoradial projection reduced underestimation of radiographic assessment of bone loss. LMSRT underestimated interproximal bone loss to a lesser extent than conventional evaluation by loupe.     

Paraduodenal pancreatitis as a mimicker of pancreatic adenocarcinoma: MRI evaluation

PurposeTo evaluate the MRI features of paraduodenal pancreatitis (PDP) and to define useful signs to differentiate PDP from pancreatic ductal adenocarcinoma (PDAC).Material and methodsWe reviewed the MRI scans of 56 patients, 28 affected by PDP and 28 by PDAC, all pathologically proven. The following parameters were evaluated: signal intensity of the lesion on T1-, T2-WI, DWI (b800) and after contrast medium administration; presence of cysts; dilation of common hepatic duct and main pancreatic duct; focal thickening of the second portion of the duodenum; maximum diameter and volume of the lesion.ResultsBoth PDPs and PDACs were more frequently hypointense on T1-WI, iso-hyperintense on T2-WI, hypointense in the pancreatic phase and iso-hypointense in the venous phase (p > 0.05); in the delayed phase most PDP were hyperintense (p = 0.0031); on DWI 71.4% PDPs were isointense and all PDACs were hyperintense (p = 0.0041). Cystic components were present in 85.7% PDPs (p = 0.0011); double duct sign was present in 50% PDACs (p = 0.0048); focal thickening of the duodenum was depicted in 89.3 PDPs (p = 0.0012). PDPs were larger than PDACs (p = 0.0003).ConclusionThe most suggestive signs of PDP are: signal hyperintensity in the delayed phase, isointensity on DWI, presence of cysts, focal thickening of the duodenum and large size of the lesion.     

A hypothesis on the mechanism of action of high-dose thyroid in refractory mood disorders

Multiple lines of evidence suggest the hypothesis that high dose thyroid therapy corrects for cellular hypothyroidism found in bipolar disorders. Evidence indicates that bipolar disorders are associated with mitochondrial dysfunction which results in low cellular adenosine 5′-triphosphate (ATP) levels. Transport of thyroid hormones into cells is energy intensive and dependent on ATP except in the pituitary gland. Inadequate ATP levels makes it difficult to get thyroid hormone into cells leading to cellular hypothyroidism. This creates a condition where the blood and pituitary levels of thyroid hormone are normal but low in other tissues. High dose thyroid therapy produces a gradient that is sufficient for thyroid hormone to diffuse into cells correcting cellular hypothyroidism. If this hypothesis is correct there are number of implications. The two most important are: On average patients suffering from a bipolar disorder die 10–20 years earlier than the general population. The medical sequelae associated with bipolar disorders cause far more deaths than suicide. If high dose thyroid corrects for cellular hypothyroidism it could well decrease the medical morbidity and mortality associated with bipolar disorders that are the result of cellular hypothyroidism. Thus high dose thyroid would be a first treatment that decreases the considerable medical morbidity and mortality associated with the bipolar disorders. This would stand in stark contrast to most psychiatric medications that can that increase morbidity and mortality. It would also reinforce the safety of HDT. The second implication is thyroid hormone blood levels in patients suffering from a bipolar disorder do not accurately reflect the true thyroid status.     

特发性正常压力脑积水临床管理中国指南(2022)

步态障碍、认知障碍和膀胱功能障碍临床三联征在老年人群中涉及多种疾病,其中,特发性正常压力脑积水(iNPH)因其早期诊断和早期治疗可有效逆转病情而显得尤为重要。中国微循环学会神经变性病专业委员会脑积水学组联合中华医学会老年医学分会、北京神经变性病学会,组织国内神经内科、神经外科、影像科、精神科、康复科、流行病学等相关领域专家,在2005年版欧美iNPH国际指南,2012年日本iNPH指南(第二版)以及2016年中国iNPH诊治专家共识的基础上,密切结合中国脑积水联盟成立近五年来国内iNPH诊疗实践,并参考2021年日本iNPH第三版指南,总结了国内外iNPH诊疗和研究领域的新证据,共同撰写了本指南。本指南含流行病学、临床特征、诊断和治疗等内容,形成26条推荐意见,作为我国iNPH的诊疗规范,供相关学科临床实践中参考,以便有利于这一危害老年人身心健康的疾病能得到有效管理。     

Molecular characterization and antibiotic resistance of clinical Streptococcus dysgalactiae subsp. equisimilis in Beijing,China

Streptococcus dysgalactiae subsp. equisimilis (SDSE) is presently considered as a human pathogen associated with clinical infection. We characterized 56 SDSE isolates collected from two tertiary hospitals in Beijing, China. Sixteen distinct emm types/subtypes were detected, dominated by stG245.0 (32.1%), stG652.0 (10.7%), stG6.1 (10.7%) and stG485.0 (10.7%), and a novel stG840.0 variant type was identified. All isolates possessed virulence genes of sagA and scpA, and most carried slo (98.2%), ska (98.2%) and speG^dys (35.7%). By multilocus sequence typing (MLST) analysis, 17 individual sequence types (STs) were distinguished, including 7 newly-identified STs (26.8% of isolates), of which ST127 (30.4%), ST7 (12.5%) and ST44 (10.7%) dominated. Meanwhile, pulsed-field gel electrophoresis (PFGE) analysis revealed 33 pattern types (PTs), which were further combined into 16 pattern clusters (PCs), and 59.3% of isolates were distributed into 2 dominant PCs. Notably, emm types had both close relationship and consistency with STs and PFGE PCs. Furthermore, of 56 SDSE isolates, the predominant antibiotic resistances were erythromycin (71.4%), clindamycin (71.4%) and tetracycline (60.7%). Correspondingly, the prevalent resistance genes of macrolide and tetracycline were erm(B) (78.6%) and tet(M) (73.2%). In addition, multiple point mutations of parC, one of fluoroquinolone resistance genes, were observed (accounting for 75%), and were divided into 12 types, with parC 07 as the predominant type. Our data suggested the wide molecular diversity and distinctive regional features of SDSE from clinical infection in Beijing, China.