Acute mental change and hemiplegia after autologous fat injection

Autologous fat injection is a common procedure used for skin augmentation. It is known to be safe and simple, but severe complications have been reported at times. The authors observed a patient with acute large cerebral infarction including the territories of the anterior and middle cerebral arteries and optic nerve infarction developing after autologous fat transplantation. A 32-year-old woman was referred to the emergency room of our hospital due to sudden stupor. Thirty minutes earlier, she was undergoing cosmetic autologous fat injection into the glabella area by a plastic surgeon at a private clinic. The cause was confirmed to be anterior and middle cerebral arteries infarction on brain imaging studies. When a patient presents abrupt mental change, hemiplegia, ocular pain, or blindness after autologous fat particle injection, physicians must consider cerebral infarction and combined retinal artery occlusion.     

HIV/AIDS and lipodystrophy: Implications for clinical management in resource-limited settings

Introduction

Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings.

Methods

We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review.

Results and Discussion

Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden.

Conclusions

Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.     

慢性内脏痛及其信号转导通路的研究进展

背景 慢性内脏痛是功能性胃肠病(functional gastrointestinal disorders,FGID)和慢性胰腺炎(chronic pancreatitis,CP)的主要症状,这种疼痛不但降低患者的生活质量也是其寻求医疗帮助的主要原因,但目前有关内脏痛的确切机制仍不清楚,因而其治疗效果不佳. 目的 就当前慢性内脏痛及其信号转导通路的研究进展进行综述. 内容 介绍内脏痛及其信号转导通路、神经胶质细胞特别是脊髓小胶质细胞在慢性内脏痛中的作用. 趋向 脊髓小胶质细胞可能是未来慢性内脏痛治疗的新靶点.     

Pathogenesis, diagnosis and treatment of cerebral fat embolism

In this study, we analyzed two cases of pure cerebral fat embolism and reviewed related literatures to explore the pathogenesis, clinical manifestations, diagnosis and treatment of cerebral fat embolism, improve the treatment efficiency and reduce the misdiagnosis rate. In our cases, patients fully returned to consciousness at the different times with good prognosis, normal vital signs and without obvious sequelae. For patients with the limb fractures, who developed coma without chest distress, dyspnea or other pulmonary symptoms 12 or 24 h post injury, cerebral fat embolism should be highly suspected, except for those with intracranial lesions, such as delayed traumatic intracerebral hemorrhage, etc. The early diagnosis and comprehensive treatment can improve prognosis.     

Waist circumference,waist-hip ratio,body mass index,and prostate cancer risk: Results from the North-American case-control study Prostate Cancer & Environment Study

IntroductionThe evidence on the association between anthropometric measures quantifying body fatness and prostate cancer (PCa) risk is not entirely consistent. Associations among waist circumference (WC), waist-hip ratio, body mass index (BMI), and PCa risk were assessed in a population-based case-control study.Patients and methodsThe study included 1933 incident PCa cases diagnosed between 2005 and 2009. Population controls were 1994 age-matched (±5 y) Montreal residents selected from electoral lists. Information on sociodemographics, medical history including PCa screening, height, weight, and waist and hip circumferences was collected through interviews. Logistic regression was used to assess odds ratios (ORs) for the association between anthropometric measures, and overall and grade-specific PCa.ResultsAfter adjustment for BMI, an excess risk of high-grade PCa (Gleason≥7) was associated with a WC ≥102 cm (OR = 1.47 [1.22–1.78]) and with a waist-hip ratio >1.0 (OR = 1.20 [1.01–1.43]). Men with a BMI≥30 kg/m² had a lower risk of PCa, regardless of grade. Restricting to subjects recently screened for PCa did not alter findings.ConclusionElevated BMI was associated with a lower risk of PCa, regardless of grade. Contrastingly, abdominal obesity, when adjusted for BMI, yielded results in the opposite direction. Taken together, our observations suggest that the specific body fat distribution (abdominal), for a given BMI, is a predictor of PCa risk, whereas BMI alone is not. BMI and abdominal obesity, especially when measured by the WC, should be examined conjointly in future studies on this issue and may require consideration at patient counseling.     

新生儿皮下脂肪坏死1例报告及文献回顾

目的探讨新生儿皮下脂肪坏死(Sc FN)的诊断与治疗。方法回顾性分析1例Sc FN患儿的临床资料,并结合文献分析Sc FN的病因、发病机制、鉴别诊断等。结果女性患儿,足月剖宫产,生后2 d因背部、肩部皮下硬结半天入院,抗感染治疗不佳。入院第10天患儿背部硬结局部出现软化、波动,局部穿刺液镜检示少量炎症细胞浸润,脂肪细胞变性,诊断为Sc FN。随访2月肿块消退,全身状况良好。结论 Sc FN是一种良性脂肪疾病,大多发生在有异常分娩史的足月新生儿,常发生于生后4周内,为自限性疾患,预后良好。     

Cutis laxa,fat pads and retinopathy due to ALDH18A1 mutation and review of the literature

Autosomal recessive cutis laxa (ARCL) is a connective tissue disorder characterized by wrinkled, inelastic skin, frequently associated with a neurologic involvement and multisystem disease. Next generation sequencing was performed in genetically unsolved patients with progeroid features, neurological and eye involvement to assess the underlying etiology. We describe an 6 month old child, diagnosed with a novel, homozygous nonsense mutation c.2339T>C in exon 18 of the ALDH18A1 gene, and reviewed all reported P5CS patients.So far 10 patients were described with mutations in ALDH18A1. Features of our patient that have been described in literature included cutis laxa on hands and feet, visible veins on thorax and abdomen, joint laxity, failure to thrive, short stature, microcephaly, and severe developmental and speech delay. Furthermore, abnormal fat distribution, retinal abnormalities, undescended testis, and retinitis pigmentosa have never been described in ALDH18A1. Some features described as unique in ALDH18A1 have been observed in PYCR1 patients, thus suggesting that the phenotypic overlap is higher than previously shown.In conclusion, the clinical phenotype caused by ALDH18A1 mutations is diverse, with variable degree of progeria in children, but always in association with neurologic disease. We suggest genetic testing for possible ALDH18A1 mutations in all patients with progeroid features, like wrinkled or parchment-like skin, abnormal growth, especially with central nervous system involvement and microcephaly.     

前臂皮瓣联合钛网和颊脂垫修复口腔癌术后的上颌骨缺损

目的观察前臂皮瓣联合钛网和颊脂垫修复上颌骨缺损的临床效果。方法对3例上颌牙龈癌和1例腭部腺样囊性癌分别行上颌骨次全切除或全切除术,遗留的缺损用4 cm×5 cm~5 cm×7 cm大小的前臂皮瓣联合钛网和颊脂垫修复。其中钛网用于恢复上颌骨前外侧面、牙槽突和腭部形态,前臂皮瓣用于修复腭部口腔面黏膜缺损,颊脂垫用于修复腭部鼻腔面黏膜缺损。术后通过临床检查及CT和鼻内窥镜检查评价其效果。结果随访1~3年,肿瘤无复发,移植皮瓣全部成活,面部外形及牙槽突和腭部形态恢复良好,鼻腔面钛网被软组织覆盖,佩戴可摘局部义齿修复缺牙后,语言和进食功能恢复良好。结论前臂皮瓣联合钛网和颊脂垫修复上颌骨缺损效果理想。