Association between vitiligo and subsequent risk of dementia: A population‐based cohort study

Increasing evidence suggests a positive association between autoimmune disorders and the subsequent risk of dementia, supporting the idea that neuroinflammation is a major contributor to dementia. However, whether or not adults with vitiligo have an increased risk of dementia remains unclear. We aimed to investigate the association between vitiligo and the subsequent risk of dementia. A total of 1320 patients with vitiligo and 5280 matched controls were identified from the Taiwan National Health Insurance Research Database between 1998 and 2011. Dementia was diagnosed by board‐certificated psychiatrists or neurologists in the follow‐up period. Cox proportional hazards models were used to estimate the adjusted hazard ratios (aHR) after controlling for age, sex, income‐related monthly premium, residence and comorbidities associated with dementia. The incidence rate of dementia (per 100 000 person‐years) was 502.8 among patients with vitiligo and 101.9 among the controls. Patients with vitiligo were more likely to develop any type of dementia (aHR, 5.30; 95% confidence interval [CI], 3.30–8.51), Alzheimer’s disease (aHR, 12.22; 95% CI, 3.71–40.28) and vascular dementia (aHR, 3.99; 95% CI, 1.31–12.15) compared with the controls. In conclusion, middle‐aged and old patients with vitiligo are more likely to develop dementia compared with those without vitiligo. This novel finding reminds physicians to be more careful about signs of dementia when managing patients with vitiligo and provides the basis for further investigations that clarify the underlying mechanisms.     

人为提高儿童肱骨髁上骨折外侧克氏针出针点的可行性及置针经验分析

目的初步探讨人为提高儿童肱骨髁上骨折外侧克氏针出针点的可行性及其相应的置入方法。方法本研究分为两个阶段。第一阶段:收集2016年3月至2016年12月中国医科大学附属盛京医院161例儿童伸直型肱骨髁上骨折外侧针构型病例术中透视图像中最外侧针的出针点和入针点位置,测量最外侧针冠状面和矢状面钢针角度。第二阶段(2017年1月至2017年12月)基于第一阶段的研究结果,由中国医科大学附属盛京医院两名小儿骨科医生尝试人为提高最外侧针的出针位置(预期组),另外两名外科医生继续按照常规流程置针(对照组),对两组各项治疗参数进行比较。结果第一阶段参与回顾性研究的161例患者中,47例(29.2%)最外侧针出针点位于骨干-干骺端交界区(metaphyseal-diaphyseal junction,MDJ)上边界线以上,其中40例最外侧针(85.1%)由肱骨小头骨化中心(ossific nucleus of the capitellum,ONC)外侧或骨化中心外1/3置入(正位像),于骨化中心后1/3或骨化中心后方置入(侧位像)。冠状面和矢状面钢针平均角度分别为58.4°和90.5°。第二阶段,预期组中有47例(65.3%,47/72)患者的最外侧针出针点位于MDJ上边界线以上,而对照组中仅32例(36%,32/89)出针点位于MDJ上边界线以上。两组比较差异有统计学意义(χ2=16.134,P<0.05)结论在单纯外侧针构型中,人为提高最外侧针出针点可行。钢针路径位于正位像肱骨小头骨化中心外侧、外1/3及侧位像在肱骨小头后方或后1/3位置时更容易获得高位的出针点。     

Embolization of Urinary Tract Fistulae Using an AMPLATZER Vascular Plug and Glue

Six patients (mean age, 57.7 y ± 19.7) with persistent urinary fistulae underwent 7 urinary tract embolizations with AMPLATZER Vascular Plugs (AVPs) and glue: 5 with concomitant cavity obliteration with glue and 2 without. A single procedure was successful in resolving urinary leakage in 5 patients (71%) at a mean follow-up of 27.3 wk ± 31.5 (median, 9.7 wk; range, 4.9–80 wk). Repeat cavity embolization was required in 2 instances to achieve clinical success. Mean survival was 42.3 wk (median, 16.4 wk; range, 11.7–104 wk). Combined AVP and glue embolization may prove to be a primary approach in the control of persistent fistulae.     

A case of nodal marginal zone lymphoma with hypersensitivity to mosquito bites as initial symptom

Hypersensitivity to mosquito bites (HMB) refers to skin reactions such as bullae and necrosis, which occurs after being bitten by mosquitoes and can present with multiple systemic reactions such as fever, lymphadenopathy, hepatosplenomegaly simultaneously or subsequently. A 48‐year‐old male patient presented with recurrent erythema, nodules, papules, vesicles and bullae over upper body and bilateral limbs with itching over the sites of mosquito bite for more than 1 year with low‐grade fever and superficial lymph nodes enlargement. The patient's symptoms failed to improve from conventional anti allergic treatment although skin biopsy showed changes of HMB reaction. Subsequently, the lymph node was biopsied and was reported to be nodal marginal zone lymphoma (NMZL), and then the patient was eventually diagnosed with nodal marginal zone lymphoma with HMB. To date only one case of nodal marginal zone lymphoma with HMB has been reported from Korea, and this is the first case to be reported in China.     

中国抗生素耐药性治理的政策演变及启示

目的:本研究系统梳理了我国在不同时期实施的抗生素耐药性治理,分析政策的演变历程和原因,旨在为下一步政策制定提供启示。方法:在国家卫生健康委员会等相关部委的官方网站上,系统检索有关抗生素耐药性问题的政策文件,提取关键信息并梳理政策内容与时间节点,归纳和总结中国为应对抗生素耐药性问题所采取的政策和行动。结果:中国抗生素耐药性治理的政策演变过程可划分为三个阶段:以药品管控为主要治理策略的第一阶段,以临床监测为主要治理手段的第二阶段,多领域参与的全面治理策略的第三阶段。结论:为进一步解决抗生素耐药性问题,中国应加强社区感染控制和抗生素合理使用,加强对农业和环境领域的耐药性治理,建立基于"One Health"框架下的跨部门、跨学科合作平台,并加大抗生素替代药品的研发力度。