Intracranial clear cell meningioma in two children with blood relations: two case reports and literature review

Intracranial clear cell meningioma (CCM) is very rare and often has an aggressive clinical course. The predilection site of intracranial CCM in children was cerebellopontine angle where represents challenging tumor resection because of the vicinity of brainstem, vertebral artery, and lower cranial nerve. Therefore, special consideration is required for this tumor. We report two cases with intracranial CCM in a family and reviewed the literature concerning pediatric intracranial CCM. Case 1 is a 4-year-old boy with a tumor at the right posterior fossa. Case 2 is an 8-year-old boy with a left basilar region tumor. Gross total resection and subtotal resection was achieved in case 1 and case 2, respectively. Case 1 had no tumor recurrence at 12 months after the operation. Case 2 received cyber-knife radiosurgery (CKS) after subtotal resection at 4 months, and the residual tumor had gradually shrunk. Comprehensive chromosomal number aberrations in both patients were revealed by array-comparative genomic hybridization, and loss of neurofibromatosis 2 (NF2) gene was the common genetic abnormality in the two patients. To the best of our knowledge, this is the first report concerned two patients with CCM in a family, and the findings in this article suggest that CKS is a safe and effective adjuvant therapy for residual CCM after operation and NF2 gene mutation plays a role in tumorigenesis of pediatric intracranial CCM.     

Lenke 2型特发性脊柱侧凸三维矫形手术的有限元模拟

目的 利用建立的Lenke 2型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)三维有限元模型,分别仿真模拟前路、后路手术矫形操作,探讨其最佳手术方案。方法 建立Lenke 2型AIS的有限元模型,分别模拟前路和后路共5种不同的矫形方案,比较不同手术方案的矫形效果和双肩平衡参数的变化。结果 5种不同矫形方案有限元模拟术后的上胸弯冠状面Cobb角和矫形率分别为:21.5(44.8%)、26.5(32.1%)、28.1(27.9%)、34.1(12.5%)、32(17.9%),各矫形方案的主胸弯矫正率无明显差别。胸椎矢状面生理后凸得以维持。5种矫形方案术后各双肩平衡影像学参数较术前有所升高,除方案A(上端固定椎为T2)外,其余各方案的喙突高度差均＞9 mm,锁骨角均＞2.5°,锁骨倾斜角差均＞4.5°。结论 对于左肩高的含结构性上胸弯Lenke 2型AIS,上端固定椎选择T2且完全融合上胸弯,可取得上胸弯、主胸弯良好的三维矫形和双肩平衡。部分融合上胸弯(上端固定椎为T3、T4),上胸弯的矫正率稍差,术后容易出现轻度到中度双肩失平衡。前路或后路选择性胸主弯融合,难以恢复上胸弯的正常脊柱序列,术后会导致轻度到中度双肩失平衡。     

2010—2012年复旦大学附属上海市第五人民医院世博家园门诊部抗菌药物的限定日费用分析

目的:了解复旦大学附属上海市第五人民医院世博家园门诊部(以下简称"我院")抗菌药物的限定日费用(DDC),为临床合理用药提供参考。方法:统计2010—2012年我院西药库出库记录,提取不同厂家、不同品种及不同剂型抗菌药物相关信息,采用限定日剂量法,对抗菌药物的DDC进行排序、分析。结果:3年中共用9大类抗菌药物,其中,大环内酯类药的DDC在2011年为最高(64.81元),硝基咪唑类药在2012年为最低(0.09元)。头孢菌素类药中,DDC最高的是注射用盐酸头孢替安(120.84元),最低的是头孢拉定分散片(2.41元),第1代头孢菌素各品种的DDC均未超过9.00元。大环内酯类药中,阿奇霉素干混悬剂与注射用乳糖酸阿奇霉素的DDC逐年下降,且在2012年大环内酯类药仅有1个注射与2个口服品种。氟喹诺酮类药注射与口服剂型的DDC均低于大环内酯类药,其中,2012年盐酸左氧氟沙星氯化钠注射液的DDC为21.25元,盐酸左氧氟沙星片为1.90元,诺氟沙星片为0.77元。结论:2010—2012年,我院大多数抗菌药物的DDC均呈下降趋势,但同一品种不同剂型、剂量或不同厂家的DDC存在差异。     

Stimulation and propagation of activation in conduction tissue: Implications for left bundle branch area pacing

1. Download : Download high-res image (287KB)
2. Download : Download full-size image

     

Supplementation with antioxidants attenuates transient worsening of retinopathy in diabetes caused by acute intensive insulin therapy

Background

To investigate whether insulin can increase the production of reactive oxygen species (ROS) in bovine retinal microvascular endothelial cells (BRECs), the role of antioxidants in the insulin-induced exacerbation of diabetic retinopathy and the related mechanisms.

Methods

BRECs were cultured in either 5 or 30?mM glucose for 3?days before stimulation with 100?nM insulin for 24?h or incubated with 1?mM apocynin, 100?μM LY294002, 50?μM U0126, 2?μM GF109203X, 250?U/ml catalase, 100?μg/ml ascorbic acid, 100?μM α-lipoic acid and 50?μM α-tocopherol before stimulation with 100?nM insulin. H₂O₂ (200?μM) was added to cells to measure the VEGF protein expression. Intracellular ROS was measured by immunofluorescence and flow cytometry, superoxide anion measurement was done by cytochrome c reduction, and VEGF protein was measured by ELISA analysis.

Results

Insulin or (and) high glucose significantly increased intracellular ROS production in BRECs, and pretreatment of the cells with apocynin and LY294002 decreased insulin-induced superoxide anion production. Neither pretreatment with GF109203X nor U0126 showed an effect on the superoxide anion production. Ascorbic acid, α-lipoic acid, and α-tocopherol also decreased superoxide anion production. Furthermore, H₂O₂ increased VEGF protein expression in BRECs and catalase suppressed insulin-induced VEGF protein expression.

Conclusions

Insulin can increase ROS production through an NAD(P)H, phosphatidylinositol 3′-kinase-dependent mechanism in bovine retinal microvascular endothelial cells ex vivo. ROS can regulate insulin-induced VEGF expression. Supplementation with antioxidants may help to attenuate the transient worsening of retinopathy in diabetes caused by acute intensive insulin therapy.     

尿毒症毒素与心脏损伤的再认识

心血管疾病(CVD)是慢性肾脏病(CKD),尤其是终末期肾病患者最常见的并发症及死亡原因之一。近年来,研究证实CKD患者及血液透析(HD)患者发生CVD及全因死亡率与蛋白结合毒素的蓄积密切相关。蛋白结合毒素是一类很难通过单纯HD清除的物质,大部分分子质量大于500 Da,与蛋白结合后导致蛋白自身分子结构、电荷甚至功能发生变化,抑或可能导致其他组织、器官损伤。目前研究相对较多的是同型半胱氨酸、硫酸吲哚酚、硫酸对甲酚等物质对肾脏及心血管的毒性,其可能的致病机制包括刺激内皮细胞或白细胞产生自由基,影响内皮细胞和白细胞的相互作用,损伤内皮细胞,促进血管平滑肌细胞增殖,导致动脉粥样硬化、心脏的纤维化等。     

男性急性冠状动脉综合征患者性激素、血脂和hs-CRP相关性研究

目的探讨男性急性冠状动脉综合征患者性激素睾酮水平、血脂及高敏C反应蛋白(hsCRP)的相关性。方法连续收集2012年3月~10月于上海市第五人民医院心内科因胸闷、胸痛住院的男性患者共284例,年龄50~80岁。根据冠状动脉(冠脉)造影结果分为急性冠脉综合征组(97例)和稳定性心绞痛组(105例),非冠心病组(82例)。根据冠状动脉造影结果分为三支病变、两支病变、单支病变。检测所有患者血脂、性激素睾酮和hs-CRP水平。并分析各检测指标间的相关性。结果与急性冠脉综合征组比较,稳定性心绞痛组睾酮和三酰甘油(TG)水平升高,差异有统计学意义(P均0.05),hs-CRP降低,差异有显著统计学意义(P0.01)。与急性冠脉综合征组比较,非冠心病组睾酮和TG升高,hs-CRP降低,有显著统计学差异(P均0.01)。非冠心病组较稳定性心绞痛组总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)以及睾酮水平升高,hs-CRP降低,差异有统计学意义(P均0.05)。男性冠心病睾酮与血脂、hs-CRP水平无明显相关(P均0.05)。单支病变、双支病变以及三支病变睾酮水平无统计学差异(P均0.05)。结论男性急性冠脉综合症患者睾酮水平下降、hs-CRP升高,未发现睾酮与血脂、hs-CRP相关,不同冠状动脉病变程度睾酮水平亦无统计学差异。     

肺隐球菌病临床误诊讨论

目的探讨肺隐球菌病的临床特点及诊治方法,以减少误诊。方法对我院近期收治的1例肺隐球菌病误诊病例的临床资料进行回顾性分析,并复习相关文献。结果患者因阵发性左侧背部疼痛,伴发热及咳嗽、咳痰1个月入院。曾于外院就诊,经肺部CT检查诊断为肺炎、肺结核不能排除,给予相应治疗病情加重转入我院。入院后行肺部CT检查示左肺多发渗出伴实变、下叶为著;隐球菌乳胶凝集试验(+),效价1∶480;纤维支气管镜肺活组织病理检查倾向隐球菌感染;免疫组织化学检查示CD68(组织细胞+),PAS(+),六胺银(+),抗酸(-);气管镜肺泡灌洗液检查找到新型隐球菌。确诊肺隐球菌病,予氟康唑及左氧氟沙星治疗3周后,复查胸部CT与入院时胸部CT比较肺部病灶明显吸收,出院。结论对临床表现为肺部多发渗出病灶、持续低热,且抗感染治疗效果不佳的患者应高度警惕肺隐球菌病,及时行病理检查、隐球菌乳胶凝集试验及肺泡灌洗液检查等,以减少误诊误治。     

The use of angiotensin system inhibitors correlates with longer survival in resected pancreatic adenocarcinoma patients

BackgroundActivities and inhibition of the Renin-Angiotensin-Aldosterone System (RAAS) may affect the survival of resected pancreatic ductal adenocarcinoma (PDAC) patientsMethodA single-institution retrospective analysis of resected PDAC patients between 2010 and 2019. To estimate the effect of angiotensin system inhibitors (ASIs) on patient survival, we performed Kaplan Meier analysis, Cox Proportional Hazards model, Propensity Score Matching (PSM), and inverse probability weighting (IPW) analysis.Results742 patients were included in the analysis. The average age was 67.0 years, with a median follow-up of 24.1 months. The use of ASI was associated with significantly longer overall survival in univariate (p = 0.004) and multivariable (HR = 0.70 [0.56–0.88],p = 0.003) adjusted analysis. In a propensity score-matched cohort of 400 patients, ASI use was again associated with longer overall survival (p = 0.039). Lastly, inverse probability weighting (IPW) analysis suggested that the use of ASI was associated with an average treatment effect on the treated (ATT) of HR = 0.68 [0.53–0.86],p = 0.002) for overall survival.ConclusionIn this single-institution retrospective study focusing on resected PDAC patients, the use of ASI was associated with longer overall survival in multiple statistical models. Prospective clinical trials are needed before routine clinical implementation of ASI as an adjuvant to existing therapy can be recommended.     

稽留流产绒毛中线粒体膜电位和活性氧的变化

目的:通过对稽留流产患者绒毛滋养叶细胞中线粒体膜电位(mitochondrial membrane potential MMP)、活性氧物质(reactive oxygen species ROS)的测定,探讨MMP、ROS与稽留流产的关系。方法:稽留流产患者20例作为研究组,正常早孕要求流产妇女20例作为对照组。研究组20例胚胎稽留宫内时间<4周。应用荧光分光光度计和流式细胞仪检测研究组及对照组绒毛滋养叶细胞中线粒体膜电位(MMP)、活性氧物质(ROS)的水平。结果:与正常早孕妇女相比较,稽留流产患者绒毛滋养叶细胞中MMP水平显著降低(P<0.05),ROS水平显著增高(P<0.05)。结论:绒毛滋养叶细胞中线粒体膜电位下降、活性氧物质增多可能是稽留流产发生的信号。