Medical Histories of Control Subjects Influence the Biomarker Potential of Plasma Aβ in Alzheimer’s Disease: a Meta-analysis

Whether blood amyloid-β (Aβ) could be a peripheral biomarker of Alzheimer’s disease (AD) remains in dispute. In the present study, we conducted a meta-analysis with 19 citations searched from Embase, PubMed, and the Cochrane Library database. Weighted mean difference (WMD) with 95% confidence intervals (CIs) was used to estimate the effect size. We firstly analyzed the plasma Aβ40, Aβ42, and Aβ42/Aβ40 ratio in AD and control group subjects. However, only a lower level of plasma Aβ42 was figured out in AD group subjects with weak statistical significance (WMD 1.82; 95% CI 0.59, 3.06; P = 0.004; I2 = 84%). We considered that the medical histories of control subjects could influence the biomarker ability of plasma Aβ. Therefore, subgroup analyses were then carried out based on a new recruiting criterion for control subjects, defining as no afflictions of any Aβ-related diseases. Surprisingly, AD group subjects showed a significant decrease in plasma Aβ42/Aβ40 ratio with low heterogeneity among studies (WMD 0.02; 95% CI 0.02, 0.02; P < 0.00001; I2 = 0%). Moreover, not only the Aβ42/Aβ40 ratio but also Aβ42 and Aβ40 were indifferent between AD and pseudo-control subjects which might be afflicted with Aβ-related diseases. This meta-analysis demonstrated that medical histories of control subjects were interference factors impeding plasma Aβ to be a biomarker of AD.     

36例乳房外Paget病临床特点分析

 目的:对乳房外Paget病进行回顾性研究，为临床诊治提供帮助。方法：对2013年1月至2018年12月我院确诊的36例乳房外Paget病患者的临床资料进行回顾性分析。结果：36例患者男女比例为3 ∶1；平均发病年龄(65.72±10.41)岁；病程6个月至10年，中位病程4年；皮损多为单发，阴囊常见；主要表现为红斑、糜烂；既往误诊率60.61%；免疫组化以CK7、CEA、EMA阳性表达为主；不伴有转移者30例，伴有转移者6例；30例行局部扩大切除术+术中冰冻治疗，其中27例扩切范围明确，扩大切除范围以1.0 cm、2.0 cm为主，扩切2.0 cm的一次切净率为90.91%。术后有2例复发。结论：该病男性好发，老年多见，皮损多为单发，误诊率高，免疫组化有提示原发或继发意义，病情进展缓慢但仍可发生转移，治疗以局部扩大切除术+术中冰冻为主，建议扩切范围在2.0 cm及以上。该病术后仍有较高复发率。     

Fam114A1蛋白对黑素细胞生物学功能影响的初步研究

【摘要】 目的 初步探讨Fam114A1对黑素细胞生物学功能的影响。方法 以黑素瘤细胞A375为工具细胞株，通过慢病毒转染的方式构建稳定过表达和抑制Fam114A1蛋白的细胞株，即过表达组和表达抑制组，以转染空载慢病毒的A375细胞作为对照组。实时荧光定量PCR检测Fam114A1对黑素合成相关基因酪氨酸酶（TYR）、酪氨酸酶相关蛋白1（TYRP1）、前黑素小体蛋白（PMEL）、小眼畸形相关转录因子（MITF）和多巴色素异构酶（DCT）mRNA表达的影响，Western印迹法检测TYR、MITF蛋白的表达，MTT法、Transwell迁移和黏附实验分别检测Fam114A1对A375细胞增殖活性、迁移细胞数及黏附能力的影响。统计分析采用单因素方差分析和Dunnett-t检验。结果 荧光显微镜观察慢病毒转染效率均在90%左右。与对照组A375细胞Fam114A1相对表达水平（0.850 ± 0.120）相比，过表达组显著升高（1.507 ± 0.170，t = 5.888，P = 0.001），而表达抑制组显著降低（0.397 ± 0.120，t = 4.065，P = 0.007），成功构建稳定过表达和抑制Fam114A1的A375细胞株。实时荧光定量PCR及Western印迹结果显示，表达抑制组TYR和MITF mRNA及蛋白表达均显著低于对照组（均P < 0.01），而过表达组TYR和MITF mRNA及蛋白表达与对照组差异无统计学意义（均P > 0.05）。与对照组相比，表达抑制组细胞增殖活性和黏附能力显著增强（P = 0.009、0.001），细胞迁移能力显著减弱（P = 0.005），而过表达组仅细胞迁移能力显著增强（P = 0.021）。结论 Fam114A1可影响A375的增殖活性、迁移和黏附能力，且影响黑素合成相关蛋白TYR和MITF的表达，可能是一种参与调控黑素细胞生物学活性的功能蛋白。     

Parkinson’s disease and the gastrointestinal microbiome

Journal of Neurology - Recently, there has been a surge in awareness of the gastrointestinal microbiome (GM) and its role in health and disease. Of particular note is an association between the GM...     

Skin testing of gallic acid‐based hair dye in paraphenylenediamine/paratoluenediamine‐reactive patients

Incidence of allergic contact dermatitis (ACD) to para‐phenylenediamine (PPD)/paratoluenediamine (PTD) hair dyes is increasing. Hair dyes utilizing gallic acid (GA) may be a safe alternative. However, pretesting is recommended. We investigated the contact sensitivity to ingredients of a dye product; GA, monoethanolamine thioglycolate (MT), l ‐cystein and ferrous sulfate, and an appropriate pretest method in 31 patients reactive to PPD and/or PTD. An open test was performed with the test dye following the patch test. Subsequently, a use test was performed twice, with a 4‐week interval. One subject showed a positive reaction to ferrous sulfate in the patch test. Another subject reacted to the first compound alone in the open test. Thirteen subjects manifesting cutaneous lesions from previous regular hair dyeing, showed reactions at the first use of the test dye; and six had reactions with reduced severity at the second test. GA and MT are safe for use in ACD patients reactive to PPD and/or PTD. For predicting contact allergy to hair dyes, the open test appeared to be a better pretest method than the patch test.     

The role of the dynorphin/κ opioid receptor system in anxiety

Anxiety disorders are the most common and prevalent forms of psychiatric disease, although the biological basis of anxiety is not well understood. The dynorphin/κ opioid receptor system is widely distributed in the central nervous system and has been shown to play a critical role in modulating mood and emotional behaviors. In the present review, we summarize current literature relating to the role played by the dynorphin/κ opioid receptor system in anxiety and κ opioid receptor antagonists as potential therapeutic agents for the treatment of anxiety disorders.     

A randomised controlled trial of the effectiveness of soft silicone multi‐layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial

The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi‐layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex^® Border Sacrum and Mepilex^® Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi‐layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer.     

Jefferson骨折复位钢板的设计、改良及初步临床应用

 目的介绍Jefferson骨折复位钢板系统（Jefferson-fracture reduction plate, JeRP）及其相关参数,评估其改良前后的临床疗效。方法对Jefferson骨折患者应用螺旋CT三维重建排除寰椎横韧带断裂后,采用原型JeRP系统进行手术治疗,分析其初步临床应用的疗效及出现的问题。根据应用中的不足,通过寰椎三维重建模型,进行应用解剖学研究并测量相关解剖数据,重新确定寰椎侧块上、下位螺钉的最佳进钉点和长度,根据该数据设计、改良JeRP钢板并予以临床应用。术后采用颈椎过伸、过屈位X线片评估是否存在寰枢椎不稳,应用CT扫描观察骨折愈合情况。结果8例Jefferson骨折患者行经口咽寰椎骨折复位、原型JeRP钢板内固定术,术后平均随访6.3个月,所有患者术后枕颈部疼痛逐渐改善,咽后壁切口愈合良好,未见感染,骨折均达到解剖复位及骨性愈合,术后随访未见寰枢椎失稳,但其中3例患者因寰椎侧块上位螺钉穿破寰枕关节而导致颈椎活动受限。针对此问题,并通过应用解剖学测量,模拟置钉显示寰椎侧块外1/3平分线与寰椎上、下关节面交点所形成线段的中点作为寰椎侧块上位螺钉的进钉点,可保证JeRP钢板侧块上位螺钉不穿透上关节面,同时可保证足够空间置入下位螺钉,具备临床可行性。根据此结果设计出改良JeRP钢板,应用于4例Jefferson骨折患者,术后影像学检查证实所有螺钉均位于寰椎的侧块中。结论原型JeRP初步应用显示较好的疗效,但仍存在寰椎侧块上位螺钉穿透寰枕关节的可能;改良后钢板的设计更加符合寰椎的解剖结构,基本可以保证螺钉位于侧块中。     

急性有机磷农药中毒患者抗胆碱药联合应用方法的研究

目的观察长、短效抗胆碱药不同联合治疗方法对重度急性有机磷农药中毒(AOPP)救治效果的影响。方法将80例重度AOPP患者随机分为A组(41例)及B组(39例),A组在入院后即行阿托品、戊乙奎醚联合治疗;B组应用阿托品达阿托品化后再联合应用戊乙奎醚,维持阿托品化状态,所有患者给予同样的护理干预。记录阿托品化时间、意识恢复时间、胆碱酯酶活力恢复50%以上时间、住院时间、戊乙奎醚用量、药物耐受、药物依赖、迟发性神经病、中间综合征、中毒反跳、阿托品中毒及死亡情况。结果两组阿托品化时间、意识恢复时间、戊乙奎醚用量、胆碱酯酶活力恢复50%以上时间、住院时间、药物耐受、药物依赖、中毒反跳、阿托品中毒情况比较,差异有统计学意义(P0.05,P0.01);两组迟发性神经病、中间综合征、病死率比较,差异无统计学意义(均P0.05)。结论阿托品持续泵入快速达阿托品化后,用小剂量阿托品、戊乙奎醚联合应用维持阿托品化状态治疗重度AOPP效果较好,可减少患者中毒反跳、阿托品中毒的发生,使患者平稳渡过危险期,缩短住院时间,戊乙奎醚的用量小,减少了治疗费用。