新型抗精神病药物对肝功能的影响及帕利哌酮的优势

目的探索新型抗精神病药对肝功能的影响,以及帕利哌酮与其他新型抗精神病药相比是否具有优势。方法采用病例回顾研究方法,收集2010年1月-2014年2月北京回龙观医院新入院精神分裂症患者91例,均符合《国际疾病分类(第10版)》(ICD-10)诊断标准。给予单一或联合新型抗精神病药系统治疗,于治疗前后检测血清丙氨酸转氨酶(ALT)、门冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、血清总胆汁酸(TBA)、总胆红素(T-BIL)、直接胆红素(D-BIL)、间接胆红素(I-BIL)、白蛋白/球蛋白(A/G)水平。结果使用新型抗精神病药物治疗后肝功能异常率为14.28%。用药后ALT、GGT、TBA水平增加,ALT、TBA异常率增加,差异有统计学意义(P0.05)。T-BIL、D-BIL、I-BIL水平下降,I-BIL异常率下降,差异有统计学意义(P0.05)。方差分析显示,帕利哌酮组、利培酮组和其他组三组间血清ALT水平差异有统计学意义(F=3.664,P=0.03),多重比较显示,帕利哌酮组分别与其他两组血清ALT水平差异有统计学意义(P0.05)。结论新型抗精神病药物对肝功能的影响主要体现在对肝细胞实质的影响。帕利哌酮与其他新型抗精神病药相比对肝脏的安全性更好。     

改善妊娠合并人类免疫缺陷病毒感染者不良结局相关因素分析

目的探讨改善妊娠合并人类免疫缺陷病毒(HIV)感染者不良结局的相关因素。方法对2009年5月至2010年5月广州市第八人民医院收治的65例HIV感染孕妇的临床情况进行分析,并对以下分组妊娠结局进行比较(65例中终止妊娠10例,仅对余55例进行分析)。(1)全程实施母婴阻断措施的39例为研究组,未全程实施母婴阻断措施的16例为对照组。(2)研究组中,孕13~27+6周开始实施母婴阻断措施的23例为中孕期组,孕28周后开始实施母婴阻断措施的16例为晚孕期组。(3)产前7d内末梢血CD4+ T淋巴细胞数大于200个/μL者为A组,小于200个/μL者为B组。结果 (1)研究组与对照组早产、低体重儿、胎膜早破、羊水过少、胎儿畸形、胎儿窘迫发生情况比较,除胎儿窘迫外,差异均有统计学意义(P<0.05)。(2)中孕期组与晚孕期组早产、低体重儿、羊水过少、胎儿窘迫、胎膜早破发生情况比较,除胎膜早破外,差异均有统计学意义(P<0.05)。(3)A组与B组早产、低体重儿、胎儿窘迫、羊水过少、胎儿畸形和产后发热发生情况比较,差异均有统计学意义(P<0.05)。结论婚前检查和产前筛查、孕妇末梢血CD4+ T淋巴细胞数、全程母婴阻断...     

Long-lasting allergic patch test reaction caused by gold

Allergic contact dermatitis caused by gold is rare, and only isolated cases have been reported. Patch Jesting with gold may cause a long-lasing reaction. The purpose of this study is to describe a well-studied case of gold allergy caused by denial gold crowns. A gold-sensitized patient and a non-sensitized control subject were examined using patch tests, immunohistochemistry. electron microscopy and blast transformation reactions. Sodium thiosulfate, auranofin and sodium thiomalate gave positive patch test reactions. Immunohistochemistry and electron microscopy were performed from biopsies taken from allergic patch lest reactions caused by gold sodium thiosulfate 1 day and 17 days after applying the patches, from normal skin and from a 17-day-old allergic patch test reaction caused by ammonium persulfate. Down-regulation had taken place by 17 days in the allergic ammonium persulfate reaction, but not in the 17-day allergic gold lest reaction. The patient reacted to all but one of the gold-induced blast transformation tests, sodium chloroaurate being non-inductive. The non-sensitized control subject did not exhibit any reactions. In conclusion, gold sodium thiosulfate, gold sodium thiomalate and auranofin can be used as patch test substances for gold allergy, though long-lasting allergic patch test reactions may develop. In vitro gold salt induced blast transformation is an alternative test for gold allergy. The slow down-regulation of the allergic patch test reactions needs to be studied further.     

A case of acral lentginous melanoma: the correlation between CD95L expression on melanoma cells and apoptosis of tumor infiltrating lymphocytes

There is an increasing amount of evidence that melanoma cells express the ligand for CD95 (CD95L), a potent inducer of apoptosis which contributes to creating the immune privileged circumstances of tumor sites. However, it still remains to be demonstrated whether the capacity of melanoma cells to express CD95L is acquired during the progression. We addressed this question with a case of acral lentiginous melanoma by employing immunostaining using an antibody directed against CD95L as well as by in situ TUNEL staining. H&E-staining of tumor specimens revealed that there were two different growth patterns. The central part of the tumor showed a deeper invasion into the dermis (Breslow thickness >4 -mm). The horizontally growing edge of the tumor proliferated more superficially (Breslow thickness<3-mm). Relatively fewer lymphocytes were observed around the melanoma nests in central areas, which expressed detectable amounts of CD95L. In contrast, more lymphocytes were observed among the melanoma cells in the peripheral lesion, where CD95L was not detected. To evaluate the relevance of the CD95L expression, in situ TUNEL staining was performed. This indicated a significant correlation of lymphocyte apoptosis with CD95L expression on melanoma cells. Together the data suggest that expression of CD95L is turned on depending on the level of melanoma, and that it may tribute to creating immune privileged circumstances by initiating apoptosis of tumor filrating lymphocytes.     

Lymphocyte blood levels that remain low can predict the death of patients with COVID-19

The outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been rapidly spreading on a global scale and poses a great threat to human health. However, efficient indicators for disease severity have not been fully investigated. Here, we aim to investigate whether dynamic changes of lymphocyte counts can predict the deterioration of patients with COVID-19.We collected data from 2923 patients with laboratory-confirmed COVID-19. Patients were then screened, and we focused on 145 severe cases and 60 critical cases (29 recovered cases, 31 deaths). The length of hospitalization was divided into five time points, namely admission, 25%, 50%, 75% and discharge or death, according to the principle of interquartile distance. A series of laboratory findings and clinical data were collected and analyzed during hospitalization. The results showed that there were differences in levels of leukocytes, neutrophils and lymphocytes at almost every time point in the severe cases and 60 critical cases (29 recovered cases, 31 deaths). Further analysis showed that 70.2% of the COVID-19 cases had low circulating lymphocyte count, of which 64.1% were severe cases and 85.0% were critical cases (75.9% recovered cases and 93.5% died). Moreover, the lymphocyte count in dead cases was significantly lower than that of critical cases who recovered, at almost every time point in the critical groups. We also divided critical patients into group A (<1.1 × 10⁹/L) and group B (>1.1 × 10⁹/L) according to number of lymphocytes. Through survival analysis, we found that there was no significant difference in survival between group A and group B at admission (P = .3065). However, the survival rate according to lymphocyte levels in group A was significantly lower than that of group B at 25% hospital stay (on average day 6.5), 50% and 75% time points (P < .001).Lymphocyte counts that remain lower after the first week following symptom onset are highly predictive of in-hospital death of adults with COVID-19. This predictor may help clinicians identify patients with a poor prognosis and may be useful for guiding clinical decision-making at an early stage.     

Somatosensory abnormalities in atypical odontalgia: A case-control study

Somatosensory function in patients with persistent idiopathic types of orofacial pain like atypical odontalgia (AO) is not well described. This study tested the hypothesis that AO patients have significantly more somatosensory abnormalities than age- and sex-matched controls. Forty-six AO patients and 35 controls participated. Inclusion criteria for AO were pain in a region where a tooth had been endodontically or surgically treated, persistent pain >6 months, and lack of clinical and radiological findings. The examination included qualitative tests and a battery of intraoral quantitative sensory testing (QST). Most AO patients (85%) had qualitative somatosensory abnormality compared with few controls (14%). The most common qualitative abnormalities in AO patients were found with pin-prick 67.4%, cold 47.8%, and touch 46.5% compared with 11.4%, 8.6%, and 2.9%, respectively, in the control group (P<0.001). Between-group differences were seen for many intraoral QST: mechanical detection threshold, mechanical pain threshold (pinprick), dynamic mechanical allodynia (brush), dynamic mechanical allodynia (vibration), wind-up ratio, and pressure pain threshold (P<0.01). In the trigeminal area, between-group differences in thermal thresholds were nonsignificant while differences in cold detection at the thenar eminence were significant. Individual somatosensory profiles revealed complex patterns with hyper- and hyposensitivity to intraoral QST. Between-group differences in pressure pain thresholds (P<0.02) were observed at the thenar eminence. In conclusion, significant abnormalities in intraoral somatosensory function were observed in AO, which may reflect peripheral and central sensitization of trigeminal pathways. More generalized sensitization of the nociceptive system may also be part of AO pathophysiology.     

Atypical CLN2 with later onset and prolonged course: a neuropathologic study showing different sensitivity of neuronal subpopulations to TPP1 deficiency

This is the first neuropathology report of a male patient (born 1960-died 1975) with an extremely rare, atypical variant of CLN2 that has been diagnosed only in five families so far. The clinical history started during his preschool years with relatively mild motor and psychological difficulties, but with normal intellect and vision. Since age six there were progressive cerebellar and extrapyramidal symptomatology, amaurosis, and mental deterioration. Epileptic seizures were absent. The child died aged 15 years in extreme cachexy. Neuropathology revealed neurolysosomal storage of autofluorescent, curvilinear and subunit c of mitochondrial ATP synthase (SCMAS) rich material. The neuronal storage led to laminar neuronal depopulation in the cerebral cortex and to a practically total eradication of the cerebellar cortical neurons. The other areas of the central nervous system including hippocampus, which are usually heavily affected in classical forms of CLN2, displayed either a lesser degree or absence of neuronal storage, or storage without significant neuronal loss. Transformation of the stored material to the spheroid like perikaryal inclusions was rudimentary. The follow-up, after 30 years, showed heterozygous values of TPP1 (tripeptidylpeptidase 1) activity in the white blood cells of both parents and the sister. DNA analysis of CLN2 gene identified a paternal frequent null mutation c.622C > T (p.Arg208 X) in the 6th exon and a maternal novel mutation c.1439 T > G in exon 12 (p.Val480Gly). TPP1 immunohistochemistry using a specific antibody gave negative results in the brain and other organs. Our report supports the notion that the spectrum of CLN2 phenotypes may be surprisingly broad. The study revealed variable sensitivities in neuronal subpopulations to the metabolic defect which may be responsible for the variant's serious course.     

Subcutaneous metastasis at the operative route of an atypical meningioma of the tentorium. Case report and literature review

Metastatic spreading is a rare complication of meningioma. We report a subcutaneous metastasis from an atypical meningioma of the tentorium. A 69-year-old man presented with a meningioma of the tentorium. The tumor was totally resected. The histological diagnosis was atypical meningioma. The tumor recurred two years later and was irradiated. Despite irradiation, the tumor progressed and was resected three years later. Five months following the second surgery, an isolated subcutaneous mass developed at the skin incision and was resected. The histological examination of the subcutaneous tumor showed histological features of atypical meningioma. Surgery of atypical meningioma carries the risk of iatrogenic metastasis, despite previous irradiation.