Case of autoimmune neutropenia with severe marginal periodontitis

Early onset periodontitis is rarely seen in infants, though often leads to an acute and serious clinical course when encountered in such patients. Autoimmune neutropenia presents systemic and dental symptoms, as depressed resistance to bacterial infection is caused by a disorder that reduces the number of neutrophils. This disease can result in not only gingival inflammation but also destruction of periodontal tissues, such as attachment loss, alveolar bone absorption, and early tooth loss in primary as well as mixed dentition. Here, we report treatment of a child with marginal periodontitis from the age of 3 years–7 years 9 months. No systemic manifestations were noted until 3 years of age, thus the patient had never received a detailed examination or medication related to the disease. Following examinations at our department, we referred the patient to a pediatrician at our university hospital for possible systemic disease, who made a diagnosis of autoimmune neutropenia. Although administration of antibiotics and professional dental care were continued, neutrophil count was not increased and progressive periodontal destruction was observed. Extraction of teeth with poor prognosis was performed and a prosthetic strategy for the missing teeth developed. It is important to recognize that periodontitis along with autoimmune neutropenia can appear in infants, even though the incidence is quite low. Early detection and early treatment of this disease is necessary for delaying progression of periodontitis and optimal occlusal induction of permanent teeth.     

Detectability and surgical outcomes in parathyroid surgery – a single-centre experience

The incidence of primary hyperparathyroidismand referrals for the removal of parathyroid adenomas are increasing. Factors that improve the detectability, and ultimately the surgical outcome, are the focus of this retrospective study. We included 117 patients who had parathyroid operations with intraoperative monitoring of parathyroid hormone (PTH). Sestamibi, ultrasound and, in selected cases, fusion with computed tomograms (CT), were done to locate the lesion preoperatively. Concentrations of calcium and PTH before and after operation, specimen weight, and preoperative vitamin D concentrations, were assessed. The sensitivity of sestamibi and ultrasound for the preoperative location of adenomas was 92% and 80%, respectively. Sestamibi located them more accurately in patients with low preoperative concentrations of vitamin D (p = 0.037) and with heavier adenomas (p < 0.001). We found no significant association between the preoperative concentrations of PTH and detectability on preoperative scans (p = 0.058). Postoperative follow up showed that 97% of the 117 patients were biochemically cured. Accurate location helps to lower morbidity as it facilitates a targeted approach. Further studies are needed to explore the role of vitamin D in the location of parathyroid adenomas before parathyroidectomy.     

Enfermería Familiar y Comunitaria: claves de presente,retos de futuro

It is the mission of the Community and Family Nurse through an integral and holistic approach to accompany people from cradle to death in developing their health potential, and promote different family, work and social environments to facilitate this development.Throughout history, various international, European and national organizations have regulated the figure of the Community and Family Nurse, and now their functions, powers and professional performance are fully regulated.The Community and Family Nurse can respond to the needs of a changing population and take on new responsibilities in management and research.Their extensive basic and advanced skills gathered under a rigorous training programme, benefit the health system, the nursing profession, citizenry and its communities.Many challenges remain for the Health Departments of each Autonomous Region to make it possible for this specialty to develop its full potential for improving care.     

不同类型原发性三叉神经痛的手术疗效分析

目的 探讨不同类型的责任血管及压迫特点对原发性三叉神经痛手术疗效的影响。方法 回顾性分析2002~2012年微血管减压术治疗的212例原发性三叉神经痛的临床资料。根据术中发现责任血管类型分为动脉压迫（155例）、静脉压迫（24例）和混合压迫（33例），根据术中发现责任血管压迫特点分为接触压迫型（123例）和粘连包裹型（89例）。结果 手术总有效率为95.8%，动脉压迫、静脉压迫和混合压迫有效率分别为98.1%、95.8%和84.8%，接触压迫型和粘连包裹型有效率分别为98.4%和92.1%。结论 微血管减压术是治疗原发性三叉神经痛的有效方法，动静脉混合压迫以及术中粘连包裹可能是影响手术疗效的因素。     

Hsa-miR-4282对肝癌细胞系SMMC-7721生长的影响

目的  探讨Hsa-miR-4282在肝癌细胞系SMMC-7721中的表达及其对细胞生长的影响。方法 采用实时荧光定量PCR法检测Hsa-miR-4282在人正常肝上皮细胞系HL-7702和人肝癌细胞系MHCC97-H、SMMC-7721，以及 20例肝癌组织及其相应癌旁组织中的表达。采用瞬时转染法将Hsa-miR-4282 mimics（上调组）和Hsa-miR-4282 inhibitor（下调组）分别转染肝癌SMMC-7721细胞，上调组和下调组分别设置相应阴性对照组。转染后采用MTT法检测细胞增殖能力，平板克隆形成实验检测细胞克隆形成能力，流式细胞仪检测细胞凋亡能力。结果 Hsa-miR-4282在肝癌组织、肝癌细胞MHCC97-H及肝癌细胞SMMC-7721中的表达均低于癌旁组织及正常肝细胞HL-7702（P＜0.05）。MTT实验结果显示，Hsa-miR-4282上调后肝癌SMMC-7721细胞的OD值低于其阴性对照组，而下调后OD值高于其阴性对照组 （P＜0.05）。平板克隆形成实验显示，下调组的细胞克隆数高于其阴性对照组［（240±7） 个 vs （191±10） 个，P=0.005）］，而上调组细胞克隆数低于基阴性对照组［（146±10） 个 vs （193±12） 个，P=0.013）］。流式细胞仪检测结果显示，Hsa-miR-4282上调组细胞凋亡率较其阴性对照组升高［（23.89±1.89）% vs（16.6±1.14）%，P=0.009）］，下调组细胞凋亡率较期阴性对照组降低［（14.98±0.46）% vs （17.79±0.73）%，P=0.010］。结论 Hsa-miR-4282上调可抑制肝癌SMMC-7721细胞增殖，促进细胞凋亡，可能与肝癌的发病机制有关。     

肾上腺静脉成像在原发性醛固酮增多症诊断中的研究进展

原发性醛固酮增多症是继发性高血压常见的病因之一，其分型和病变定位对于临床治疗方法的选择及其预后具有重要的临床意义。影像检查包括肾上腺静脉采血、增强多层螺旋CT以及非增强MR血管成像等，其中增强多层螺旋CT成像可清楚显示肾上腺静脉的形态和位置。将常用的评价肾上腺静脉的影像检查方法加以阐述，并讨论其研究进展和发展趋势。     

Prior malignancy impact on survival outcomes of glioblastoma multiforme; population-based study

Background: Glioblastoma multiforme (GBM) patients with a prior malignancy are usually excluded from clinical trials on GBM based on the assumption that this history will affect their survival outcomes. This practice may affect clinical trial accrual and limit the gathering of knowledge essential to the formulation of therapeutic options for this patient population. However, not much is known about the real impact of these prior malignancies on the survival of patients with subsequent GBM. We aimed to investigate the degree of such an impact.

Patients and methods: We used the Surveillance, Epidemiology, and End Results (SEER) Program to analyze data of GBM patients diagnosed between 1973 and 2014. We calculated the overall and GBM-specific survival of these patients using the unadjusted Kaplan-Meier test and the multivariable covariate-adjusted Cox models.

Results: Of 51,158 GBM patients, 3,076 had a prior malignancy. The unadjusted Kaplan-Meier test showed worse overall and GBM-specific survivals for patients who had a prior history of cancer. However, after adjusting for age at diagnosis of GBM, sex, race, marital status, and conduction of surgery, multivariable covariate-adjusted Cox models showed that having a prior malignancy did not significantly affect neither overall survival (HR?=?1.025, 95%CI?=?.986?-?1.066, p?=?.213) nor GBM-specific survival (HR?=?1.005, 95%CI?=?.963?-?1.049, p?=?.810).

Conclusions: Our findings suggest that the broad practice of excluding patients with a prior history of cancer should be reconsidered as it may adversely affect accrual, trial completion rates, and generalizability of the results.     

Endoscopic gastroplasty to treat medically uncontrolled obesity needs more quality data: A systematic review

Endoscopic gastroplasty (EG) has been used in clinical practice to treat obesity. This systematic review has the objective of assessing if there is an acceptable level of scientific evidence on the safety and effectiveness of EG. A thorough search strategy was used up to October 2018, including the 2 most common techniques: endoscopic suturing and the primary obesity surgery endolumenal procedure. The quality of the studies was evaluated through the Joanna Briggs Institute Critical Appraisal tools for use in Systematic Reviews—“Checklist for Case Series”—and summarized using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Only 1 randomized controlled trial (moderate GRADE evidence) was found, and the remaining were case reports or small case series (very low GRADE evidence). The literature has low scientific quality. All studies, with 1 exception, are small case series with short follow-up. One of the randomized controlled trials did not meet the primary endpoint for weight loss in both groups (EG × sham) after 1-year follow-up. The case series reported from 16% to 19% total weight loss, but few had more than 6 months of follow-up. Serious adverse events ranged from 2% to 10%. Based on current literature, there is not enough quality scientific evidence regarding long-term weight loss and the procedure’s safety to recommend the use of EG in current clinical practice.