驱虫药脑病的MRI诊断价值及发病机制探讨

目的 评价MRI对驱虫药脑病的诊断价值，探讨该病的发病机制。资料与方法 52例患者分2组行MRI检查。第一组为临床初诊驱虫药脑病患者22例，用MRI检查帮助诊断，总结最后确诊病例的MRI表现并探讨该病发病机制。第二组根据已总结的MRI征象随机诊断该病30例，并与确诊病例数比较，判断MRI表现的诊断特异性。结果 与服驱虫药后偶合起病的其他疾病发病率约27％（6／22），MRI能诊断其中大部分疾病。驱虫药脑病的MRI表现大多类似脱随鞘病变或散发性脑炎，其MRI诊断特异性约63％。结论 MRI在驱虫药脑病的诊断及发病机制的研究中均具有重要作用。     

Coexistence of alcohol-related pancreatitis and alcohol-related liver disease: A systematic review and meta-analysis

BackgroundAvailable estimates of coexistent alcohol-related pancreatitis (ALP) and alcohol-related liver disease (ALD) vary widely, and factors that determine coexistent disease are largely unknown. We performed a systematic review of published literature with the primary aim to generate robust estimates for coexistent alcohol-related chronic pancreatitis (ACP) and alcohol-related cirrhosis (ALC).MethodsWe searched PubMed, EMBASE, and Web of Science databases from inception until February 2018. Studies included were those in English-language, sample size ≥25 and allowed calculation of the coexistent disease. Pooled estimates were calculated using a random-effects model approach.ResultsTwenty-nine (including 5 autopsy studies) of 2000 eligible studies met inclusion criteria. Only 6.9% included patients were female. Fifteen studies enabled calculation of ACP in ALC, and 11 for ALC in ACP. Pooled prevalence of ACP in ALC was 16.2% (95% CI 10.4–24.5) overall, and 15.5% (95% CI 8.0–27.7) when data were limited to clinical studies. Corresponding prevalence for ALC in ACP was 21.5% (95% CI 12.0–35.6) and 16.9% (95% CI 11.5–24.3), respectively. There was significant heterogeneity among studies (I² – 65–92%). Pooled prevalence for ALP in ALD or ALD in ALP in clinical studies were 15.2% and 39%, respectively. None of the studies reported outcomes in patients with coexistent disease.ConclusionA sizeable fraction of patients with ACP or ALC have coexistent disease. Future studies should define the prevalence of coexistent disease in women and minority populations, and the consequences of coexistent disease on clinical presentation and short- and long-term outcomes.     

Application of a new classification of chimeric anterolateral thigh free flaps

BackgroundThe anterolateral thigh free flap is one of the most commonly used flaps in reconstructive procedures. The purpose of this study was to assess this new classification of chimeric anterolateral thigh free flaps.MethodsSixty-five patients underwent free anterolateral thigh chimeric free flap reconstruction of defects in the head and neck region. We summarized the anatomic features of perforators, including the number and origin of the perforators.ResultsSixty-five cases of femoral anterolateral double island flaps were divided into 3 types: trunk type (type I), 11 cases (16.9%), in which the perforators of two flaps originated in the descending branch and the transverse branch of the lateral femoral circumflex artery; branch type (type II), 45 cases (69.3%), in which both the perforators originated in the descending branch or the transverse branch of the lateral femoral circumflex artery; and bifurcation type (type III), 9 cases (13.8%), in which two perforators originated in the bifurcation of one perforator that originated in the descending branch or the transverse branch of the lateral femoral circumflex artery. All 65 flaps survived and none showed partial necrosis.ConclusionsThe anterolateral thigh chimeric flap can be divided into 3 types: trunk type (I type), branch type (II type) and bifurcation type (III type).     

镍钛合金听泡植入对豚鼠耳蜗及听功能的毒性

背景：镍钛合金多作为自膨胀支架和封堵器的材料应用已很成熟,但镍钛合金作为听骨链重建材料的相关研究及临床应用至今少有报道。 目的：观察镍钛合金植入体在豚鼠听泡中的耳毒性。 方法：健康听敏纯白红目豚鼠50只,每只豚鼠其中一侧耳为镍钛合金植入组,其中25只对侧耳为钛植入组,另25只对侧耳为空白植入组。分别于植入后7,14,28,56,112 d随机处死含钛植入组和空白植入组的豚鼠各5只,对各组行近中轴位耳蜗石蜡切片苏木精-伊红染色观察耳蜗组织的形态变化,行耳蜗毛细胞核丫啶橙-碘化丙啶双重荧光染色观察毛细胞凋亡和缺失情况,行耳蜗基底膜扫描电镜观察毛细胞纤毛排列情况,透射电镜观察毛细胞细胞器形态,对各组的豚鼠植入前、不同时间点处死前均行听性脑干反应及畸变反应耳声发射检测。 结果与结论：各组植入后各时间点耳蜗组织形态无明显变化,未发现耳蜗毛细胞发生凋亡,基底膜耳蜗毛细胞纤毛排列整齐,外耳蜗毛细胞的细胞器未见明显异常。植入前及植入后7,14,28,56,112 d听性脑干反应阈值差异无显著性意义,且畸变反应耳声发射检测通过率均为100%。结果证实,镍钛合金听泡植入对豚鼠耳蜗形态及听功能无明显影响,提示镍钛合金无明显耳毒性。     

Méningites à pneumocoque : actualités,perspectives

Streptococcus pneumoniae is the most frequent cause of severe meningitis in adults. Effective antibiotic treatment must be given early, before lumbar puncture, even if a CT scan is needed. In France, 40% of pneumococci have a decreased susceptibility to penicillin. As a consequence, the recommended probabilistic treatment is the association of a third-generation cephalosporin and vancomycin. Neurological complications are the consequence of cytotoxic and vasogenic cerebral edema. Until now corticosteroids have failed to improve the prognosis of patients with pneumococcal meningitis. Other treatments, such as anti-TNF antibodies or antioxidants, seem to be able to decrease the risk of cerebral damages in some experimental models.     

Effects of BDNF Val66Met polymorphisms on brain structures and behaviors in adolescents with conduct disorder

Accumulating evidence suggests that neural abnormalities in conduct disorder (CD) may be subject to genetic influences, but few imaging studies have taken genetic variants into consideration. The Val66Met polymorphism of brain-derived neurotrophic factor (BDNF) has emerged as a high-interest genetic variant due to its importance in cortical maturation, and several studies have implicated its involvement in neurodevelopmental disorders. Thus, it is unclear how this polymorphism may influence brain anatomy and aberrant behaviors in CD. A total of 65 male adolescents with CD and 69 gender-, IQ- and socioeconomic status-matched healthy controls (HCs) (age range 13–17 years) were enrolled in this study. Analyses of variance (ANOVAs) were used to assess the main effects of CD diagnosis, BDNF genotype, and diagnosis–genotype interactions on brain anatomy and behaviors. We detected a significant main effect of BDNF genotype on temporal gyrification and antisocial behaviors, but not on CD symptoms. Diagnosis–genotype interactive effects were found for cortical thickness of the superior temporal and adjacent areas. These results suggest that the BDNF Val66Met polymorphism may exert its influence both on neural alterations and delinquent behaviors in CD patients. This initial evidence highlights the importance of elucidating potentially different pathways between BDNF genotype and cortical alterations or delinquent behaviors in CD patients.

     

Correlation between distribution of muscle weakness,electrophysiological findings and CTG expansion in myotonic dystrophy

Myotonic dystrophy type 1 (DM-1) is a multi-system disorder affecting the muscles, brain, cardiovascular system, endocrine system, eyes and skin. Diagnosis is made by clinical, electrodiagnostic and genetic studies. This study aimed to determine the correlation between CTG expansion and distribution of muscle weakness and clinical and electrophysiological findings. Genetically confirmed DM-1 patients presenting to Shariati Hospital between 2005 and 2011 were included in this study. Clinical, electrodiagnostic and genetic testing was performed and the correlation between CTG expansion and distribution of muscle weakness and clinical and electromyographic findings was studied. Thirty-three genetically confirmed DM-1 patients were enrolled. Myotonia, bifacial weakness and distal upper limb weakness were seen in all patients. Diabetes mellitus was found in one patient (3%), cardiac disturbance in eight (24.2%), cataracts in eight (24.2%), hypogonadism in five (15.2%), frontal baldness in 13 (39.4%), temporalis wasting in 14 (42.4%), temporomandibular joint disorder in seven (21.2%) and mental retardation in eight (24.2%). The mean number of CTG repeats, measured by Southern blot, was 8780 (range 500–15,833). A negative correlation was found between CTG expansion and age of onset. Temporalis wasting and mental retardation were positively correlated with CTG expansion. No relationship was found between weakness distribution, electromyographic findings, other systemic features and CTG expansion. In this study of DM-1 in Iran, we found a correlation between CTG expansion and age of onset, temporalis wasting and mental disability. No correlation between CTG expansion and electrodiagnostic and other clinical findings were detected.