Outcome of idiopathic intracranial hypertension after laparoscopic sleeve gastrectomy

BackgroundIdiopathic intracranial hypertension (IIH) predominantly affects young, obese women and presents with signs and symptoms of increased intracranial pressure, such as headaches and visual impairment.ObjectiveWe aim to present our experience in the management of IIH.SettingUniversity Hospital.MethodsObese IIH patients who had a laparoscopic sleeve gastrectomy during the study period (2 years) were included. Data were retrieved from prospectively collected database. Headaches, visual alterations, and medications or interventions used to treat are discussed.ResultsThe study included 16 obese women with IIH. Mean age was 31 ± 2 years (range, 25–44 yr) and mean body mass index was 46 ± 4 kg/m² (range, 42–53 kg/m²). Main symptoms and signs were chronic headaches (14), impaired vision (15), vision loss (1), papilledema (6), and field defects in 4 patients. Symptoms were present for a mean of 5 years (4–11). History of medical treatment with carbonic anhydrase inhibitor (acetazolamide) and thecoperitoneal shunting was present in 12 and 9 patients, respectively. Mean lumbar puncture opening pressure was 41.2 ± 21- (range, 30–64) cm water. At 12 months after laparoscopic sleeve gastrectomy, body mass index and percentage excess weight loss were 27.8 ± 1 kg/m² and 75.2 ± 2%, respectively. Symptoms gradually improved with complete resolution in all but 2 patients (87.5%).ConclusionThe present work emphasizes the role of bariatric surgery in the management of obese patients with IIH. Larger, prospective, controlled studies are needed.     

腹腔镜胃袖状切除术后修正手术选择及评价

我国减重手术例数逐年增加,其中腹腔镜胃袖状切除术（LSG）约占总手术例数的60%,随着手术例数的增加伴随而来的是面临术后严重并发症和复胖问题处理的挑战。对于术前严重并发症或复胖保守治疗无效的病人,修正手术是其治疗的最佳方式。目前,国内外修正手术种类繁多,术后治疗效果不一,如何选择修正手术的方式是保证手术效果使病人获益的关键。LSG术后复胖病人的修正手术要求病人在接受内科治疗及饮食运动治疗无效后,在符合手术适应证的基础上,经过MDT讨论后再选择手术方式。相较其他修正手术方式,现阶段LRYGB是符合各类修正手术指征的手术方式,具体操作中手术方式的选择则因病人病情而异。     

TURBT术后序贯放化疗治疗对老年 MIBC 患者生存时间及生活质量的影响

目的:探讨经尿道膀胱肿瘤电切术（transurethral resection of bladder tumor,TURBT）术后序贯放化疗治疗对老年肌层浸润性膀胱癌（muscular invasive bladder cancer,MIBC）患者生存时间及生活质量的影响。方法:回顾性分析我院2012年03月至2016年12月收治老年MIBC患者共68例临床资料,其中38例采用膀胱根治切除方案设为对照组,30例采用TURBT术后序贯放化疗方案设为观察组;比较两组总生存时间、肿瘤特异性生存时间及手术前后QOL评分。结果:入选患者随访14~58个月,中位随访时间为37.0个月;其中观察组总生存率和肿瘤特异性生存率分别为66.67%（20/30）,80.00%（24/30）;对照组总生存率和肿瘤特异性生存率分别为65.79%（25/38）,81.58%（31/38）;两组总生存率和肿瘤特异性生存率比较差异无统计学意义（P＞0.05）;两组术后6个月QOL评分显著低于术前（P＜0.05）;但观察组术后6个月QOL评分显著高于对照组（P＜0.05）。结论:老年MIBC患者采用TURBT术后序贯放化疗方案可获得与膀胱根治切除方案相近的生存获益,且术后生活质量显著改善。     

Pyk2蛋白在非肌层浸润性膀胱癌中的表达及与该肿瘤预后的相关性

目的探讨富含脯氨酸的蛋白酪氨酸激酶2(Pyk2)蛋白在非肌层浸润性膀胱癌中的表达及与该肿瘤预后的相关性。方法选取62例非肌层浸润性膀胱癌患者为研究对象,患者经手术切除后取膀胱癌病灶标本为观察组,另取相应患者的癌旁正常黏膜组织标本为对照组。采用免疫组化法对观察组、对照组Pyk2蛋白的阳性表达率、表达水平进行统计对比。分析Pyk2蛋白与非肌层浸润性膀胱癌临床病理特征的关系,并对Pyk2蛋白的表达情况与非肌层浸润性膀胱癌预后效果间的相关性进行探讨。结果观察组Pyk2蛋白阳性表达率、表达水平均高于对照组,组间对比差异有统计学意义(P<0.05)。Pyk2蛋白表达与非肌层浸润性膀胱癌患者年龄、性别、病灶大小、病灶数等因素无关,而与患者的肿瘤分期、分化程度有关。Pyk2蛋白阳性表达组患者的复发率高于阴性表达组,无进展生存期(PFS)、总生存期(OS)水平均低于Pyk2蛋白阴性表达患者。结论Pyk2蛋白在非肌层浸润性膀胱癌患者病灶组织中呈现高表达,其表达情况与非肌层浸润性膀胱癌病灶的浸润、转移、分期有密切关系,并与患者的肿瘤预后效果显著相关。Pyk2蛋白的检测对于非肌层浸润性膀胱癌病情评估、预后效果判断有指导意义。     

Assessment of cardiac autonomic function in patients with Duchenne muscular dystrophy using short term heart rate variability measures

BackgroundDuchenne muscular dystrophy (DMD) is a hereditary neuromuscular disorder frequently associated with progressive cardiac dysfunction, and is one of the common causes of death in these children. Early diagnostic markers of cardiac involvement might help in timely intervention. In this study we compared the short term HRV measures of DMD children with that of healthy subjects.MethodOne hundred and twenty-four genetically confirmed boys with DMD and 50 age matched controls were recruited. Error-free, electrocardiogram was recorded in all subjects at rest in the supine position. HRV parameters were computed in time and frequency domains. Time domain measures included standard deviation of NN interval (SDNN), and root of square mean of successive NN interval (RMSSD). Frequency domain consisted of total, low frequency and high frequency power values. Ratio of low frequency and high frequency power values (LF/HF) was determined using customized software.ResultsHRV parameters were significantly altered in DMD children as compared to healthy controls. Following parameters [mean (SD)] were reduced in DMD as compared to controls; RMSSD (in ms) [52.14 (33.2) vs 64.64 (43.2); p = 0.038], High frequency component (nu) [38.77 (14.4) vs 48.02 (17.1); p = 0.001] suggesting a loss of vagal tone. In contrast, measure of sympathovagal balance LF/HF [1.18 (0.87) vs 0.89 (0.79); p = 0.020] was increased in DMD group.ConclusionIn this cross sectional study we have demonstrated alteration in autonomic tone in DMD. Loss of vagal tone and an increase in sympathetic tone were observed in DMD children. Further prospective studies are required to confirm the utility of these measures as predictors of adverse cardiac outcome in DMD.     

Responsiveness and Minimal Clinically Important Difference of the Motor Function Measure in Collagen VI-Related Dystrophies and Laminin Alpha2-Related Muscular Dystrophy

ObjectivesTo investigate the responsiveness of the motor function measure (MFM) and determine the minimal clinically important difference (MCID) in individuals with 2 common types of congenital muscular dystrophy (CMD).DesignObservational, prospective, single center, cohort study.SettingNational Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH).ParticipantsIndividuals (N=44) with collagen VI-related dystrophies (COL6-RD, n=23) and 21 individuals laminin alpha2-related muscular dystrophy (LAMA2-RD, n=21) enrolled in a 4-year longitudinal natural history study.InterventionsNot applicable.Main Outcome MeasuresResponsiveness of the MFM-32 and the Rasch-scaled MFM-25 and the MCID of the MFM-32 determined from a patient-reported anchor with 2 different methods, within-patient and between-patient.ResultsThe original MFM-32 and Rasch-scaled MFM-25 performed similarly overall in both the COL6-RD and LAMA2-RD populations, with all subscores (D1, standing and transfers; D2, axial and proximal; D3, distal) showing a significant decrease over time, except MFM D1 and D3 for LAMA2-RD. The MFM D1 subscore was the most sensitive to change for ambulant individuals, whereas the MFM D2 subscore was the most sensitive to change for nonambulant individuals. The MCID for the MFM-32 total score was calculated as 2.5 and 3.9 percentage points according to 2 different methods.ConclusionsThe MFM showed strong responsiveness in individuals with LAMA2-RD and COL6-RD. Because a floor effect was identified more prominently with the Rasch-Scaled MFM-25, the use of the original MFM-32 as a quantitative variable with the assumption of scale linearity appears to be a good compromise. When designing clinical trials in congenital muscular dystrophies, the use of MCID for MFM should be considered to determine if a given intervention effects show not only a statistically significant change but also a clinically meaningful change.     

神经源性肌萎缩的MRI表现

目的：探讨神经源性肌萎缩的病变肌肉的MRI表现及MRI的应用价值。材料和方法：选择30例经临床证实的神经源性肌萎缩患者，选择舌头、肩胛肌带、大腿及双侧手掌行MRI检查。结果：①肌萎缩侧索硬化症者15例，其中舌肌萎缩4例；手掌蚓状肌及骨间肌萎缩6例，受累肌肉见斑片状长T2等T1异常信号影；双侧大腿肌肉见片状混杂信号影1例；4例表现为双侧手掌肌肉萎缩，信号无异常。余受检部位肌肉形态及信号无明显异常。②脊肌萎缩症1例，腓骨肌萎缩症2例，均表现双下肢肌肉萎缩，肌肉内见短T1长T2异常信号。③平山病8例，表现受累肌肉萎缩，手掌蚓状肌及骨间肌见斑片状长T2等T1异常信号影；④4例为单侧下肢的神经源性肌萎缩，表现为肌肉萎缩，肌肉内可见斑片状长T2及短T1混杂信号影。结论：神经源性肌萎缩主要表现为病变区肌肉的萎缩，部分肌肉为脂肪替代，另有部分病变肌肉可表现为肌纤维的坏死性改变。     

脂肪基质细胞移植治疗杜氏型肌营养不良的临床观察

目的：观察脂肪基质细胞（ADSCs）移植治疗杜氏型肌营养不良（DMD）前后血清酶学变化及临床效果。方法：选择2009-06～2011-06莱芜市人民医院神经内科DMD患者,其中男性48例,女性3例;年龄1～20岁,平均年龄13.3岁。阳性家族史22例。经莱芜市人民医院伦理委员会同意,并征求患者本人及家人签字同意后,进行自体ADSCs移植治疗,设自身治疗前后血清酶学变化对照方法进行疗效观察,应用四肢肌内注射的方式进行ADSCs移植。结果：ADSCs移植治疗12个月肌力增加者占患者总数的64.8%。血清肌酸激酶（CK）降低率80.4%,血清乳酸脱氢酶（LDH）降低率78.4%。结论：ADSCs移植治疗DMD,对肌肉组织有一定的修复作用,使DMD患者的运动功能得到改善,肌力有所提高,血清酶学较移植前下降。ADSCs移植无不良反应,患者依从性好,是治疗DMD的新手段。     

Muscular disorders in tension-type headache

In order to evaluate the diagnostic criteria for muscular disorders in tension-type headache, pericranial muscle tenderness and pressure pain thresholds were studied in a random sample population of 735 adults aged 25–64. In addition, quantitative EMGs were recorded in 547 of these subjects. The correlation between the three diagnostic tests was assessed and the discriminality and cut-off points were analysed using Receiver Operating Characteristics analysis. Local tenderness from the temporal muscles was closely related to the total tenderness scores from 14 pairs of muscles. In chronic tension-type headache, tenderness was positively related to EMG and inversely related to pain thresholds. In the episodic form the total tenderness score was inversely related to pain thresholds, whereas no significant relation to EMG was noted. The Receiver Operating Characteristics curves indicated that tenderness recorded by manual palpation was the most specific and sensitive test, whereas EMG and pain thresholds were of limited diagnostic value. Eighty-seven percent of subjects with the chronic, and 66% of subjects with the episodic form were found to have a "muscular disorder" defined as increased tenderness recorded by either manual palpation or pressure algometry and/or increased EMG levels. However, muscle tenderness increased significantly during pain, so the headache state should be considered in future studies. Suggestions for revision of the present diagnostic criteria for muscular disorders are given.