Primary Conservative Therapy for Symptomatic Isolated Mesenteric Artery Dissection with Severely Compressed True Lumen or Large Dissecting Aneurysm

PurposeTo investigate the safety and effectiveness of primary conservative therapy for patients with symptomatic isolated mesenteric artery dissection (IMAD) with a severely compressed true lumen and/or a large dissecting aneurysm.Materials and MethodsA total of 35 consecutive patients (all men; median age, 53 y) with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture who were treated with primary conservative therapy between November 2018 and February 2020 were assessed. A severely compressed true lumen was defined as luminal stenosis > 70%. A large dissecting aneurysm was defined as dissecting aneurysm diameter ≥ 1.5 times larger than the normal mesenteric artery diameter.ResultsThere was a strong positive relationship among abdominal pain, degree of luminal stenosis, and length of dissection (R = 0.811; P < .001). Conservative treatment was successful in all patients. Abdominal pain was eliminated within 4.7 d ± 4.8 (range, 2–31 d) in all patients, within 3.6 d ± 1.2 (range, 2–6) in the 31 patients with minor or moderate abdominal pain, and within 13.3 d ± 11.9 (range, 6–31 d) in the 4 patients with severe abdominal pain. Complete or partial remodeling of the mesenteric artery was achieved in 6 (17.1%) and 29 (82.9%) patients, respectively, during 8.6 mo ± 4.3 of follow-up.ConclusionsPrimary conservative therapy can be used safely and effectively in patients with symptomatic IMAD with a severely compressed true lumen and/or a large dissecting aneurysm but without intestinal necrosis or arterial rupture.     

Gastrointestinal immunopathology of food protein–induced enterocolitis syndrome and other non-immunoglobulin E–mediated food allergic diseases

ObjectiveTo provide a concise summary of the current literature regarding gastrointestinal immunopathology of food protein–induced enterocolitis syndrome (FPIES) and other non-immunoglobulin E (IgE)–mediated food allergic diseases.Data SourcesData were extracted from PubMed, MEDLINE, and ScienceDirect databases.Study SelectionsOriginal articles, review articles, and guidelines published in the past 5 years in peer-reviewed journals were first summarized. The original articles cited were then reviewed and relevant results were extracted.ResultsPatients with FPIES and non-IgE–mediated food allergic diseases developed vomiting, diarrhea, and food aversion expelled food allergen from their bodies. Aside from T helper type 2 (T_H2) immunity, T_H1, T_H17, innate immunity, and epithelial mucosal barrier defect were also found to be important in the pathogenesis. Eosinophils, widely identified in the biopsy samples, were key players or were late-recruited cells for tissue repairs in those diseases. Intestinal dysbiosis and their metabolites stimulated enterochromaffin cells or enteroendocrine cells to produce serotonin, interfering with intestinal motility and subsequently affecting brain function. FPIES and non-IgE–mediated food allergic diseases were likely part of the atopic march. Allergic inflammation in intestinal mucosa might result in subsequent inflammation in the airway mucosa, suggesting the theory of “one mucosa, one disease.”ConclusionThe immune responses of FPIES and non-IgE–mediated food allergic diseases were not limited to the gastrointestinal tract, but also trigger wider inflammatory responses beyond it. Further research will be required to determine the systemic effect and intestinal microbiome of those diseases.     

Impaired Sensorimotor Gating Using the Acoustic Prepulse Inhibition Paradigm in Individuals at a Clinical High Risk for Psychosis

Many robust studies have investigated prepulse inhibition (PPI) in patients with schizophrenia. Recent evidence indicates that PPI may help identify individuals who are at clinical high risk for psychosis (CHR). Selective attention to prepulse stimulus can specifically enhance PPI in healthy subjects; however, this enhancement effect is not observed in patients with schizophrenia. Modified PPI measurement with selective attentional modulation using perceived spatial separation (PSS) condition may be a more robust and sensitive index of PPI impairment in CHR individuals. The current study investigated an improved PSSPPI condition in CHR individuals compared with patients with first-episode schizophrenia (FES) and healthy controls (HC) and evaluated the accuracy of PPI in predicting CHR from HC. We included 53 FESs, 55 CHR individuals, and 53 HCs. CHRs were rated on the Structured Interview for Prodromal Syndromes. The measures of perceived spatial co-location PPI (PSCPPI) and PSSPPI conditions were applied using 60- and 120-ms lead intervals. Compared with HC, the CHR group had lower PSSPPI level (Inter-stimulus interval [ISI] = 60 ms, P < .001; ISI = 120 ms, P < .001). PSSPPI showed an effect size (ES) between CHR and HC (ISI = 60 ms, Cohen’s d = 0.91; ISI = 120 ms, Cohen’s d = 0.98); on PSSPPI using 60-ms lead interval, ES grade increased from CHR to FES. The area under the receiver operating characteristic curve for PSSPPI was greater than that for PSCPPI. CHR individuals showed a PSSPPI deficit similar to FES, with greater ES and sensitivity. PSSPPI appears a promising objective approach for preliminary identification of CHR individuals.     

Reliable Thyroid Carcinoma Detection with Real-Time Intelligent Analysis of Ultrasound Images

Thyroid carcinoma is one of the most common endocrine diseases globally, and the incidence has been on the rise in recent years. Ultrasound imaging is the primary clinical method for early thyroid nodule diagnosis. Regions of interest (ROIs) of nodules in ultrasound images are difficult to detect because of their irregular shape nand vague margins. Accurate real-time thyroid nodule detection can provide ROIs for subsequent nodule diagnosis automatically, avoid variabilities between the subjective interpretations and inter-observer effectively and alleviate the workloads of medical practitioners. The aim of this study was to present a reliable, real-time detection method based on the Faster R-CNN (region-based convolutional network) framework for accurate and fast detection of thyroid nodules in ultrasound images. Our study proposed a faster and more accurate thyroid nodule detection method based on the Faster R-CNN framework by adding three strategies: feature pyramid, spatial remapping and anchor-box redesign. Specifically, the network takes raw ultrasound images as inputs and generates boxes with positions and the possibilities that these boxes contain thyroid nodules. The proposed method could locate and detect target nodules accurately with a mean average precision of 92.79% with more than 9000 patient images. In addition, the detection rate has accelerated to >16 frames per second, four times faster than that of the initial network. Therefore, it can meet the requirements of clinical application. The performance of the fivefold cross-validation was also accurate and robust. The proposed automatic thyroid nodule detection method yields better performance in accuracy and detection speed, which indicates the potential value of our method in assisting clinical ultrasound image interpretation.     

儿童指突状树突细胞肉瘤合并骨髓增生异常综合征一例报告并文献复习

指突状树突细胞肉瘤(interdigitating dendritic cell sarcoma,IDCS)是一种罕见的树突状细胞肿瘤,目前全球仅百余例报道,常以无痛性淋巴结肿大起病,侵袭性较强、预后较差[1-2]。骨髓增生异常综合征(myelodysplastic syndromes,MDS)为起源于造血干、祖细胞的恶性克隆性疾病,以单系或多系病态造血、易向白血病转化为特征,目前被认为是一种老年性疾病[3]。本研究报道1例同患IDCS和MDS的患儿,为国内外首次报道2种肿瘤同时发生,旨在探讨2种肿瘤的诊治要点,避免漏诊、误诊。     

缺氧诱导因子-1α参与肝纤维化形成机制研究进展

目的 肝纤维化是一种由于反复肝损伤而导致肝组织细胞外基质过多沉积导致的疾病。缺氧损伤为肝损伤的一部分,缺氧诱导因子-1α(HIF-1α)是响应缺氧应激的关键转录因子,在肝纤维化组织和活化的肝星状细胞(HSC)表达显著增加。目前,通过对大量HIF-1α依赖性基因和信号通路的研究,确认这些基因及其通路的变化参与肝纤维化发展过程,并可能在肝纤维化发生发展过程中起关键作用。本文综述了HIF-1α相关的信号通路参与肝纤维化发展的相关机制,并对上游影响HIF-1α合成和降解的相关信号通路进行了阐述,为其作为新型治疗靶点的可能潜力提供依据。     

大量饮酒及乙醇戒断后对大鼠脑内维生素C 水平的影响

目的 研究大量饮酒4 d及乙醇戒断后大鼠脑脊液中及各重要脑区内维生素C（VC）水平 及钠依赖性VC 转运体2（SVCT2）蛋白水平的变化。方法 30 只健康Wistar 大鼠随机分为5 组，对照组 （A 组）、大量饮酒4 d（B 组）、大量饮酒4 d 后戒断1 d（C 组）、大量饮酒4 d 后戒断2 d（D组）、大量饮酒 4 d后戒断7 d（E组），每组6只。B、C、D、E组大鼠大量灌胃给予乙醇4 d，乙醇浓度为25% W/V，每8小时 灌胃1次，连续4 d；A组给予等体积蒸馏水。采用Y迷宫实验评价大鼠的空间工作记忆能力；以高效液相- 电化学法（HPLC-ECD）检测大鼠脑脊液及前额叶皮质、顶叶皮质、颞叶皮质、海马脑区内细胞内VC 含量， 免疫印迹法检测大鼠各脑区内SVCT2蛋白水平的变化。结果 （1）Y迷宫实验： C、D组大鼠自发交替反应 率分别为（24.64±15.11）% 和（41.48±13.01）%，均显著低于A 组［（75.47±8.61）%］； E 组大鼠的自发交替 反应率恢复接近正常［（61.64±11.51）%］，与A 组差异无统计学意义（P＞ 0.05）。（2）脑脊液内VC 含量：B 组大鼠脑脊液内VC 含量为（204.54±25.51）μmol/L，显著高于A 组［（145.57±18.98）μmol/L］， 而C、D 组 大鼠脑脊液内VC 水平［分别为（90.24±15.45）、（86.93±14.53）μmol/L］明显低于A、B 组，差异均有统计 学意义（均P＜ 0.001）；E 组大鼠脑脊液中VC 含量［（135.80±17.16） μmol/L］与A 组间差异无统计学意义 （P＞ 0.05）。（3）各脑区内VC 水平：B 组前额叶皮质、顶叶皮质、海马脑区脑组织匀浆（细胞内）VC 水 平变化趋势相同［分别为（1.18±0.13）、（1.14±0.12）、（1.20±0.20）μmol/g］，均显著低于A 组［分别为 （1.64±0.11）、（1.62±0.13）、（2.06±0.27）μmol/g］；C 组在乙醇戒断后，前额叶皮质、顶叶皮质、海马脑区 细胞内VC 水平［分别为（1.20±0.29）、（1.05±0.06）、（1.21±0.15）μmol/g］有所恢复，但仍明显低于A 组 （均P＜ 0.01）；C组大鼠颞叶皮质细胞内VC水平［（1.37±0.04）μmol/g］显著高于顶叶皮质（P＜0.05）；D组 各脑区细胞内VC水平均有回升趋势，前额叶皮质细胞内VC水平显著高于顶叶皮质［（1.63±0.24）μmol/g 比（1.26±0.16）μmol/g，P＜0.05］；E组前额叶皮质、顶叶皮质、颞叶皮质、海马区细胞内VC水平［分别为 （1.72±0.19）、（1.43±0.22）、（1.67±0.19）、（1.86±0.22）μmol/g］均较B组显著升高（均P＜0.01），逐渐恢复至正 常水平，海马区VC水平显著高于顶叶皮质（P＜0.05）。（4）Western blot结果显示，与A组比较，B、C、D组大 鼠前额叶皮质、顶叶皮质及C、D、E组大鼠海马区的SVCT2蛋白均显著升高（均P＜0.05）。结论 大量饮 酒4 d可致大鼠脑损伤，乙醇干预后大鼠脑脊液中及各脑区脑组织匀浆中VC水平呈现负相关的变化过程， 此过程中SVCT2蛋白表达上调，这将有助于脑脊液内的VC被转运至各脑区神经元内发挥抗氧化作用。     

Optimize the management of urological tube-related emergencies during the coronavirus disease 2019 (COVID-19) pandemic

BackgroundTo introduce and determine the value of optimized strategies for the management of urological tube-related emergencies with increased incidence, complexity and operational risk during the global spread of coronavirus disease 2019 (COVID-19).MethodsAll emergent urological patients at Tongji Hospital, Wuhan, during the period of January 23 (the beginning of lockdown in Wuhan) to March 23, 2020, and the corresponding period in 2019 were recruited to form this study’s COVID-19 group and control group, respectively. Tongji Hospital has the most concentrated and strongest Chinese medical teams to treat the largest number of severe COVID-19 patients. Patients in the control group were routinely treated, while patients in the COVID-19 group were managed following the optimized principles and strategies. The case incidence for each type of tube-related emergency was recorded. Baseline characteristics and management outcomes (surgery time, secondary complex operation rate, readmission rate, COVID-19 infection rate) were analyzed and compared across the control and COVID-19 periods.ResultsThe total emergent urological patients during the COVID-19 period was 42, whereas during the control period, it was 124. The incidence of tube-related emergencies increased from 53% to 88% (P<0.001) during the COVID-19 period. In particular, the incidence of nephrostomy tube-related (31% vs. 15%, P=0.027) and single-J stent-related problems (19% vs. 6%, P=0.009) increased significantly. The mean surgery times across the two periods were comparable. The number of secondary complex operations increased from 12 (18%) to 14 (38%) (P=0.028) during the COVID 19-period. The number of 2-week postoperative readmission decreased from 10 (15%) to 1 (3%) (P=0.049). No participants contracted during the COVID-19 period.ConclusionsUrological tube-related emergencies have been found to have a higher incidence and require more complicated and dangerous operations during the COVID-19 pandemic. However, the optimized management strategies introduced in this study are efficient, and safe for both urologists and patients.     

T1WI_Star_VIBE_FS序列在头颈部放疗MR定位中扫描方法研究

目的 对比分析T1WI_Star_VIBE_FS序列在头颈部肿瘤患者MR定位中不同扫描方式对图像质量、信噪比、对比噪声比等参数的影响,确定优选扫描方式。方法 回顾性分析 78例头颈部MR定位患者,分别采用组织补偿法(A组 23例)、分段扫描拼接法(B组 18例)和二者结合法(C组 37例)进行增强扫描,对比上述3种扫描方式获取的图像质量、颈前部软组织信噪比(SNR)和对比噪声比(CNR)的差异。结果 C组扫描方式可获取较高的图像质量评分;3种扫描方式获取图像的SNR的平均值分别为 214.70±148.78、91.95±59.26、307.61±127.80;CNR的平均值分别为 208.74±148.27、85.79±59.50、301.58±127.48;C组在图像质量评分、SNR和CNR方面均明显优于A、B组(P<0.01)。结论 推荐使用组织补偿和分段拼接扫描相结合方式作为头颈部肿瘤放疗MR定位的优选扫描方式。