听神经瘤术后面神经功能损伤危险因素分析

目的分析影响听神经瘤患者术后短期及长期面神经功能的危险因素。 方法回顾性分析厦门大学附属第一医院神经外科自2015年1月至2018年6月收治的62例听神经瘤患者的临床资料。于术后7 d及术后6个月对所有患者的面神经功能进行评估。收集可能与患者术后早期及长期面神经功能障碍存在相关性的因素，采用Logistic单因素与多因素回归对相关因素与患者术后短期及长期面神经功能的关系进行分析。 结果术后7 d，21例（33.9%）患者面神经功能正常，41例（66.1%）患者出现面神经功能损伤；术后6个月，49例（79.0%）患者面神经功能为正常，13例（21.0%）患者面神经功能损伤。Logistic单因素回归分析结果显示：肿瘤最大直径越大、肿瘤与面神经黏连越紧密，患者术后7 d发生面神经功能损伤的可能性越大（P=0.002、0.002）；术前临床症状持续时间为患者术后6个月面神经功能障碍的危险因素（P=0.035）。Logistic多因素回归分析结果显示：肿瘤与面神经的黏连程度、肿瘤最大直径为患者术后7 d面神经功能障碍的独立危险因素（P=0.003、0.014）；术前临床症状持续时间、肿瘤最大直径为患者术后6个月面神经功能障碍的独立危险因素（P=0.010、0.030）。 结论肿瘤与面神经的黏连越紧密、肿瘤最大直径越大，患者术后7 d发生面神经功能损伤的可能性越大。患者术前临床症状持续时间越长、肿瘤最大直径越大，术后6个月发生面神经功能损伤的可能性越大。     

Use of proton pump inhibitors and risk of rosacea: A nationwide population-based study

Proton pump inhibitors (PPI) are commonly used drugs. However, little is known about the association between PPI use and rosacea. This study aimed to investigate the association between PPI use and rosacea risk. Patients with prior PPI therapy, including 1067 rosacea cases and 4268 matched controls, were identified from the National Health Insurance Research Database in Taiwan. The cumulative defined daily dose (cDDD) was used to quantify the PPI use. Logistic regression was used for the analyses. After adjustment for potential confounders, PPI use with cDDD of more than 365 was significantly associated with an increased risk of rosacea (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.10–2.15). Rosacea risk was significantly associated with PPI use of cDDD of more than 365 in women (OR, 1.62; 95% CI, 1.08–2.46) but not in men. Stratified by PPI indications, risk of rosacea was significantly associated with PPI use of cDDD of more than 365 for peptic ulcer (OR, 1.58; 95% CI, 1.12–2.21). In conclusion, prolonged PPI use was associated with an increased risk of rosacea, particularly in women and patients with peptic ulcers.     

反射性共聚焦显微镜对早期蕈样肉芽肿定位诊断与疗效监测的研究

【摘要】 目的 分析早期蕈样肉芽肿（MF）皮损的反射性共聚焦显微镜（RCM）与组织病理学特征的一致性，探讨RCM作为病理学诊断早期MF的辅助价值及动态监测治疗反应的可行性。方法 2014年1月至2018年1月在杭州市第三人民医院皮肤科门诊收集临床疑诊MF病例40例，男26例，女14例，年龄（47.0 ± 17.6）岁。根据总结的早期MF的RCM特征，对活检部位进行初步定位后行组织病理学检查，对比MF的RCM与病理特征。对MF确诊病例进行窄谱中波紫外线联合干扰素治疗，运用RCM对靶向皮损跟踪随访，9个月后评价疗效。结果 在40例临床疑诊MF病例中，根据RCM特征初步诊断典型MF 8例，疑似MF18例，排除14例；根据MF病理学特征诊断典型MF12例，疑似14例，排除14例。一致性分析显示，RCM特征分类与病理诊断结果的Kappa系数为0.848，P < 0.01。RCM与组织病理学特征之间表皮低折光细胞浸润的相关性最高（Kappa系数 = 1，P = 0.005），其次是红斑期的真皮纤维化（Kappa系数 = 0.714，P = 0.035）。MF的RCM特征随着治疗的进行逐步恢复正常，但直至临床皮损完全缓解，非典型淋巴细胞依然存在。结论 RCM技术可用于早期疑诊MF皮损的病理取材定位，同时可尝试作为一种动态监测MF疗效的方法。     

Stage-specific regulation of oligodendrocyte development by Hedgehog signaling in the spinal cord

Elucidation of signaling pathways that control oligodendrocyte (OL) development is a prerequisite for developing novel strategies for myelin repair in neurological diseases. Despite the extensive work outlining the importance of Hedgehog (Hh) signaling in the commitment and generation of OL progenitor cells (OPCs), there are conflicting reports on the role of Hh signaling in regulating OL differentiation and maturation. In the present study, we systematically investigated OPC specification and differentiation in genetically modified mouse models of Smoothened (Smo), an essential component of the Hh signaling pathway in vertebrates. Through conditional gain-of-function strategy, we demonstrated that hyperactivation of Smo in neural progenitors induced transient ectopic OPC generation and precocious OL differentiation accompanied by the co-induction of Olig2 and Nkx2.2. After the commitment of OL lineage, Smo activity is not required for OL differentiation, and sustained expression of Smo in OPCs stimulated cell proliferation but inhibited terminal differentiation. These findings have uncovered the stage-specific regulation of OL development by Smo-mediated Hh signaling, providing novel insights into the molecular regulation of OL differentiation and myelin repair.     

Cover Image,Volume 80, Issue 3

Primary dysmenorrhea affects the quality of life in young women, particularly school and work performance. This study investigated the mechanisms of penehyclidine hydrochloride (PHC) efficacy on a rat model of primary dysmenorrhea. The model was induced by injecting both estradiol benzoate and oxytocin. Different doses of PHC were administrated intraperitoneally following estradiol benzoate administration. Writhing scores were assessed, and pathological changes of the uterus were observed via hematoxylin and eosin staining. Western blot and real-time PCR were used to evaluate the expression level of the M₃ receptor, both TLR₃ and TLR₄ in uterine tissue, and the level of Ca²⁺ was measured in uterine tissues. Writhing scores significantly decreased in the PHC treatment group compared to model, and PHC alleviated the occurrence of edema or necrosis in the uteri compared to model group. PHC can decrease the M₃ receptor, TLR₃, TLR₄ expression, and the Ca²⁺ level compared to the model group. PHC is a potential candidate for the future treatment of primary dysmenorrhea due to its ability to attenuate muscarinic receptors and TLRs.

Cardiovascular events associated with nicorandil administration prior to primary percutaneous coronary intervention in patients with acute ST-segment elevated myocardial infarction: a systematic review and meta-analysis

Introduction: Nicorandil may exert cardioprotective effects in ischemic heart disease. However, its efficacy in combination with early reperfusion is uncertain. The authors performed a meta-analysis of the short- and long-term clinical outcomes of nicorandil administration at the time of primary percutaneous coronary intervention (PCI) in patients with ST-elevated myocardial infarction (STEMI).

Methods: PubMed, MEDLINE, Embase, and the Cochrane Library databases were systematically searched for eligible randomized controlled studies. The primary endpoint was major adverse cardiovascular events (MACE), both in-hospital and post-discharge. The secondary endpoint was the incidence of no-reflow phenomenon.

Results: Ten studies were included (n = 1105). Mean patient age was 63.0 ± 10.0 years; 76.6% of patients were male. Compared with controls who received primary PCI, combined nicorandil/primary PCI significantly reduced in-hospital MACE (pooled odds ratio [OR] 0.16; 95% confidence interval [CI] 0.09–0.27), follow-up MACE (pooled OR 0.53; 95% CI 0.37–0.75), and total MACE (pooled OR 0.27; 95% CI 0.15–0.49). The combined treatment also reduced the incidence of no-reflow phenomenon (pooled OR 0.34; 95% CI 0.23–0.50).

Conclusion: Nicorandil administration at the time of primary PCI is associated with reduced MACE (both short- and long-term) and no-reflow phenomenon in patients with STEMI.     

Chemical constituents from the whole herb of Hemiphragma heterophyllum

Phytochemical investigation on Hemiphragma heterophyllum led to the isolation of two new compounds, heterophyllumin A (1) and heterophylliol (3), along with nine known compounds, (?)-sibiricumin A (2), iridolactone (4), jatamanin A (5), dihydrocatalpolgenin (6), 25-hydroperoxycycloart-23-en-3β-ol (7), 24-methylenecycloartanol (8), (+)-pinoresinol (9), hexadec-(4Z)-enoic acid (10), and 9,12, 15-octadecatrienoic acid (11). Their structures were elucidated on the basis of detailed spectroscopic analyses and by comparison with literature data. Further, the structure of compound 3 was unambiguously confirmed by single-crystal X-ray analysis. Some of those compounds showed moderate activity in the α-glucosidase inhibition assay.

     

长沙市新型冠状病毒肺炎流行特征分析

目的 了解长沙市新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)流行特征,为疫情防控提供依据。方法 采用描述流行病学方法对长沙市2020年1月1日—3月6日期间的新型冠状病毒肺炎流行特征进行分析。结果 2020年1月1日—3月6日期间长沙市累计报告新型冠状病毒肺炎确诊病例242例,重症率15.70%;长沙市每日报告确诊病例数自2月3日以来整体呈下降趋势。209例出院病例的住院天数为5~37 d,平均住院天数为(16.91±7.32)d;发病以30~50岁年龄组为主(23.95%),50岁以上人群的重症率最高(26.26%, χ²=14.124,P=0.001),职业以家务及待业(16.53%)和离退人员(15.70%)为主;主要临床表现为发热(65.70%)、干咳(41.74%)和乏力(33.06%)。结论 新型冠状病毒肺炎发病数虽呈下降趋势,但随着人员流动的增加,需加强防控措施防止疫情反弹。     

药物临床试验伦理审查质量风险的管理研究

目的:为提高我国药物临床试验伦理审查质量、保障受试者权益提供参考。方法:以风险管理理论为指导,运用文献研究法、专家意见法和层次分析法对药物临床试验伦理审查流程进行梳理,提取并确定影响伦理审查质量的风险因素及其权重,并对我国药物临床试验伦理审查工作提出改进建议。结果与结论:构建的药物临床试验伦理审查风险指标体系包括5个方面共31个影响因素,其中影响药物临床试验伦理审查质量的5个方面的重要性(权重)排序依次为医学伦理委员会的自身建设(0.2635)、审查会议的管理(0.2514)、跟踪审查(0.1945)、审查申请的受理与处理(0.1892)、文件档案的管理(0.1014);权重较高的影响因素包括"讨论投票过程利益冲突人员回避(0.0787)""对方案修改、知情同意修改、严重不良事件等情形及时审查或召开会议讨论(0.0705)""明确伦理审查工作流程及时间并对外公示(0.0598)""统一、规范的审查标准与批准标准(0.0521)"等。建议可通过讨论投票环节利益冲突人员予以回避,对方案修改、知情同意修改、严重不良事件等情形及时审查或召开伦理会议讨论,明确伦理审查工作流程及时间,建立统一、规范的审查标准和批准标准等方式提高药物临床试验伦理审查的质量。