肥胖与自发性脑脊液鼻漏的相关性研究

目的分析肥胖是否是自发性脑脊液鼻漏（CSFR）的独立危险因素，为预防自发性CSFR的发病及降低术后复发率提供依据。方法收集128例CSFR病例，其中男57例，女71例；年龄19~72岁，平均年龄（40.0±3.9）岁。所有患者均在鼻内镜下行脑脊液鼻漏修补术，采用中鼻甲或鼻中隔黏膜、明胶海绵贴补。所有患者入院时常规测量身高和体重，根据身高及体重计算体质指数（BMI），根据引起CSFR的病因将128例患者分为外伤性组、医源性组、肿瘤性组及自发性组。结果自发性组的BMI平均值为33.4 kg/m2，明显高于其他3组(外伤性组BMI平均值23.9 kg/m2,P=0.002;医源性组BMI平均值23.5 kg/m2,P=0.003;肿瘤性组BMI平均值21.3 kg/m2,P=0.000),差异均具有统计学意义。但外伤性组、医源性组与肿瘤性组的BMI经比较，差异无统计学意义（P均>0.05）。术后随访1年，所有患者无任何鼻部、眼部及颅底术后并发症，有5例患者术后出现复发：2例患者术后体重逐渐上升，二次手术修补，并告知患者降低体重，未再出现复发；1例患者自第1次出现复发后，自行进行减肥，未行手术治疗而自愈，随访至今，未再出现复发；2例患者无明显体重增加，二次手术修补后，未再出现复发。结论根据本研究结果，我们认为肥胖只是自发性CSFR的独立危险因素，与其他病因导致的CSFR没有相关性。控制体重是预防自发性CSFR及降低自发性CSFR术后复发率的一种重要举措。     

The sellar barrier and intraoperative CSF leak in elderly patients

Cerebral spinal fluid (CSF) leak is a significant complication in pituitary surgery, increasing both patient morbidity and mortality. In a recent publication, Campero et al. observed worse postoperative prognosis and increased risk of intraoperative CSF leak in patients with reduced sellar barrier thickness. The objective of this study was to analyze the association between sellar barrier thickness and intraoperative CSF leak in older individuals. A retrospective review was conducted of 44 transsphenoidal surgery resections for pituitary adenomas, 24 microscopic and 20 purely endoscopic procedures. Presence of intraoperative CSF fistula was significantly greater in patients with weak sellar barrier (thickness under 1 mm), compared to strong sellar barrier (52.94% vs 3.70% p < 0.0001, respectively). Application of this novel concept may help improve surgical technique selection as well as predict risk of intraoperative CSF leak and need for eventual use of flaps for reconstruction.     

基于计算流体动力学大脑中动脉闭塞急性缺血性脑卒中再灌注治疗后出血转化初步研究

目的探讨基于计算流体动力学(computational fluid dynamics,CFD)大脑中动脉闭塞引起的急性缺血性脑卒中的血流动力学与再灌注治疗后出血转化的关系。材料与方法纳入磁共振血管造影(magnetic resonance angiography,MRA)证实的大脑中动脉闭塞的急性缺血性脑卒中患者共38例,搜集治疗前MRA数据和入院时一般临床资料进行回顾性分析。基于MRA-CFD模型模拟血流动力学,获得血流动力学参数如下:血压(pressure)、壁切应力(wall shear stress,WSS)及壁切应力梯度(wall shear stress gradient,WSSG)。Rpressure、RWSS及RWSSG分别为大脑中动脉起始处与闭塞处正常管径压力、WSS及WSSG的比值。所有患者接受标准治疗。根据治疗后48 h内随访CT或MRI有无出血分为出血组和未出血组。比较两组间临床及血流动力学参数差异并进行相关性分析。结果总共纳入38例患者,出血组17例,未出血组21例。与未出血组相比,出血组有更多的高血压患者(P=0.008)、更高的入院收缩压[(149.1±23.9) mm Hg与(139.3±16.3) mm Hg比较,P=0.024]及舒张压[(90.2±16.7) mm Hg与(87.7±8.5) mm Hg比较,P=0.008]、更高的血浆同型半胱氨酸[(16.6±11.1)μmol/L与(13.2±3.5)μmol/L比较,P=0.024]。出血组较未出血组,RWSS和RWSSG更高(P<0.05),而Rpressure无统计学差异(P>0.05)。相关性分析显示高血压(r=-0.428,P=0.007)、RWSS(r=-0.341,P=0.036)与脑梗再灌注治疗后出血转化有统计学差异。结论高血压及局部血管内RWSS与大脑中动脉闭塞急性缺血性脑卒中患者再灌注治疗后出血转化有关,且入院时高血压及再灌注治疗前局部血管内高RWSS更可能导致再灌注治疗后出血转化。     

Extracts of different pollen species and their effect on human tear fluid and an epithelial cell line

Purpose: Hazelnut and birch pollen are known to destroy tear film components and attack ocular surface cells. We investigated further pollen species from different plant families, whether they show similar effects on human tear fluid and an epithelial cell line in vitro, to provide a broad basis for further research on pollen reactions affecting the tear film and ocular surface.

Materials and methods: Regional pollen species from different plant families (Adoxaceae, Betulaceae, Fagaceae, Juglandaceae, Malvaceae, Oleaceae, Pinaceae, Plantaginaceae, Poaceae, Salicaceae, Sapindaceae) were collected. Their proteolytic activity was evaluated by Zymography. Human tear fluid and cells of an epithelial cell line were incubated with pollen extracts. Tear fluid was analyzed by Polyacrylamide gel electrophoresis (PAGE). Cytomorphology was assessed microscopically and cell viability by proliferation (MTS), water-soluble tetrazolium (WST-1) assay and the impedance-based xCELLigence real-time analysis (RTCA).

Results: Zymography revealed significant protease activity and PAGE showed the degradation of tear proteins by different pollen species. Cells incubated with pollen extracts presented dose- and time-dependent cytomorphological changes. MTS, WST-1, and RTCA revealed cytostatic as well as cytotoxic effects of pollen extracts.

Conclusions: Pollen species from different plant families exert proteolytic activity and degrade human tear fluid as well as epithelial cells, which may play a crucial role in the pathogenesis of allergic and non-allergic reactions affecting the ocular surface.     

关节滑液检测在关节假体周围感染诊断中的研究进展

关节假体周围感染(periprosthetic joint infection,PJI)是人工关节置换术后可能发生的一种严重并发症,其导致的严重后果,无论对于医生还是患者来说,都很难接受。目前,由于多种不确定因素的存在,PJI诊断的准确性较低。传统的血清学检查、影像学检查有一定的价值,但是易受全身情况的影响,导致特异性不高。为了正确诊断关节假体周围感染,不同学科的研究人员采用各种不同的方法进行了大量的诊断研究,并取得了丰富的成果。近年来,关节滑液炎性标志物检测、分子生物学方法等被研究证实具有较高的敏感性和特异性。因此,关节滑液CRP、-防御素、白细胞酯酶、PCR技术等被广泛研究,期望能从中找到诊断关节假体周围感染的特异性指标,提高临床诊断的准确性。     

Sonication of Antibiotic Loaded Cement Spacers: A Valuable Technique for Detection of Infection Persistence in Two-stage Revision for Infected Joint Arthroplasty

We evaluated the diagnostic utility of sonication of antibiotic loaded cement spacers comparing with periprosthetic tissue cultures for the detection of persisting infection in 14 patients undergoing staged procedures. Sonication improved microbial detection of intraoperative cultures from 14.2% to 28.5% (P = 0.481). Routine sonication of spacers is recommended.     

Interleukin-36 alpha levels are elevated in the serum and cerebrospinal fluid of patients with neuromyelitis optica spectrum disorder and correlate with disease activity

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory neurological disease characterized by longitudinally extensive transverse myelitis (LETM) and optic neuritis. Interleukin (IL)-36 is a novel cytokine of the IL-1 family that is involved in the development of inflammatory diseases. The aim of this study was to investigate the role of IL-36α in NMOSD. We retrospectively collected 73 patients, who fulfilled the 2015 criteria for NMOSD diagnosis and were admitted to the Department of Neurology of the First Hospital of Jilin University from 2015 to 2016. Fifty age and gender matched patients with non-inflammatory neurological disorders (ONNDs) were collected in the same period and served as controls. Neurological function was evaluated by the expanded disability status scale (EDSS). All participants were assessed for the annual relapse rate (ARR). Blood and cerebrospinal fluid (CSF) samples were obtained and the levels of IL-36α in the serum and CSF were analyzed by enzyme-linked immunosorbent assay (ELISA). IL-36α levels in serum and CSF were found to be significantly increased in patients with NMOSD compared to those in the controls. Furthermore, IL-36α levels in both serum and CSF were positively correlated with the EDSS score. CSF IL-36α levels were positively correlated with CSF leukocyte counts, protein concentration and immunoglobulin IgG. Our results suggest that IL-36α may be a novel biomarker for monitoring disease severity in NMOSD.     

Unique genomic profiles obtained from cerebrospinal fluid cell-free DNA of non-small cell lung cancer patients with leptomeningeal metastases

Background: Leptomeningeal metastases (LM), associated with poor prognosis, are frequent complications of advanced non-small cell lung cancer (NSCLC) patients, especially in patients with epidermal growth factor receptor (EGFR) mutations. Due to limited access to leptomeningeal lesions, the mutational landscape of LM has not been comprehensively investigated in large cohorts and the underlining biology of LM remains elusive. Some studies have explored the potential of cerebrospinal fluid (CSF) in reflecting the molecular profile of LM but with limited number of patients enrolled.

Methods: In this study, we performed capture-based targeted sequencing using a panel consisting of 168 lung cancer-related genes on matched CSF and plasma samples from 72 advanced NSCLC patients with confirmed LM to interrogate the potential of CSF as a source of liquid biopsy.

Results: We revealed a rate of detection of 81.5% and 62.5% for CSF and plasma, respectively (p = 0.008). The maximum allelic fraction (MaxAF) was also significantly higher in CSF (43.6% vs. 4.6%) (p < 0.001). CSF, harboring a unique genomic profile by having a significant number of CSF-specific mutations, primarily copy number variations, is superior to plasma in reflecting the mutational profile of LM. Further pathway enrichment analysis revealed that most of CSF-specific mutations participated in pathways relevant to the tumorigenesis and the development of metastases. Moreover, our data also revealed that TP53 loss of heterozygosity (LOH) predominantly existed in CSF (p < 0.001).

Conclusions: Collectively, we demonstrated that CSF provides a more comprehensive profile of LM than plasma in a large cohort, thus can be used as an alternative source of liquid biopsy for LM patients.