Relationship between Neurological Deterioration and Blood Pressure/Heart Rate Variability in Patients with Acute Cerebral Infarction

ObjectivesNeurological deterioration (ND) during hospitalization is an independent predictor of poor prognosis after stroke. Risk factors affecting early ND within 48 h post stroke have been intensively investigated, while few data are available on those for late ND after transfer to a wheelchair. Therefore, it was investigated whether hemodynamic factors may affect the late ND during hospitalization.Materials and methodsA retrospective study was conducted on 135 patients with atherothrombotic or cardiogenic cerebral infarction who were admitted to our hospital between April 1st, 2014 and July 31st, 2017. During hospitalization, average, maximum, and minimum values were determined for systolic blood pressure (sBP), diastolic BP (dBP), and heart rate (HR), respectively.135 patients were classified into two groups; ND (+) group, in which modified Barthel index score at the time of transfer to a wheelchair showed five points or more decrease between wheelchair transfer and discharge, and ND (?) group, which did not. Vital indices were compared between the two groups and subjected to ROC-curve analysis.ResultsThe ND (+) group included 32 patients, and the ND (?) 103. Significant differences were found between the groups in four items; sBPmin (p = 0.029), dBPmin (p = 0.019), HRave (p = 0.028), and HRmax (p < 0.01). The ND (+) group showed lower sBPmin and dBPmin, and higher HRave and HRmax than the ND (?) group.ConclusionsLate ND after transfer to a wheelchair is related to the vital indices during hospitalization and should be cautiously managed to prevent late ND     

Skipjack tuna (Katsuwonus pelamis) eyeball oil exerts an anti-inflammatory effect by inhibiting NF-κB and MAPK activation in LPS-induced RAW 264.7 cells and croton oil-treated mice

The effect of tuna eyeball oil (TEO) on lipopolysaccharide (LPS)-induced inflammation in macrophage cells was investigated. TEO had no cytotoxicity in cell viability as compared to the control in LPS induced RAW 264.7 cells. TEO reduced the levels of NO and pro-inflammatory cytokines by up to 50% in a dose-dependent manner. The expression of NF-κB and MAPKs as well as iNOS and COX-2 proteins was reduced by TEO, which suggests that its anti-inflammatory activity is related to the suppression of the NF-κB and MAPK signaling pathways. The rate of formation of ear edema was reduced compared to that in the control at the highest dose tested. In an acute toxicity test, no mice were killed by TEO doses of up to 5000 mg/kg body weight during the two week observation period. These results suggested that TEO may have a significant effect on inflammatory factors and be a potential anti-inflammatory therapeutic.     

PI3K抑制剂ZSTK-474对结直肠癌细胞增殖和侵袭的影响

目的:探讨PI3K抑制剂ZSTK-474对结直肠癌细胞增殖和侵袭的影响。方法:采用不同浓度（0、1、2、4、6、8和10 μmol/L）ZSTK-474处理结直肠癌HT-29和HCT-116细胞24 h和48 h，CCK8法检测细胞增殖活性并计算出ZSTK-474在两株结直肠癌细胞中的半数抑制浓度（IC50）。根据IC50的值选用浓度为4 μmol/L的ZSTK-474作用HT-29和HCT-116细胞24 h，同时设置加入等量的0.1%DMSO为对照。采用平板克隆形成实验检测细胞增殖，流式细胞仪检测细胞凋亡，qRT-PCR检测细胞PI3K、Akt的mRNA水平，Western blot 检测细胞PI3K、Akt的蛋白水平。结果:ZSTK-474可明显抑制HT-29和HCT-116细胞的增殖，且呈时间和剂量依赖性。ZSTK-474可抑制HT-29和HCT-116细胞的侵袭能力，但不影响其凋亡。ZSTK-474处理HT-29和HCT-116细胞24 h后，PI3K和Akt的mRNA和蛋白表达水平均显著下降。结论:ZSTK-474能够抑制结直肠癌细胞增殖，并且能抑制其侵袭。     

体位复位经皮椎体成形术治疗骨质疏松性椎体压缩骨折

目的探讨体位复位经皮椎体成形术(PVP)治疗骨质疏松性椎体压缩骨折的疗效。方法采用体位复位PVP治疗88例GenantⅠ、Ⅱ、Ⅲ型骨质疏松性椎体压缩骨折患者。分别记录GenantⅠ、Ⅱ、Ⅲ型骨折患者的手术前后伤椎前缘高度比、伤椎后凸角、疼痛VAS评分,比较术后骨水泥渗漏情况。结果患者均获得随访,时间3~12个月。GenantⅠ、Ⅱ、Ⅲ型骨折患者的伤椎前缘高度比、伤椎后凸角、VAS评分术后2 d均较术前显著改善,差异均有统计学意义(P<0.01)。术后患者均未发生脊髓神经损伤、肺栓塞及下肢静脉血栓形成等并发症。术后17例(19.3%)发生骨水泥渗漏,其中13例渗漏到椎体旁,4例渗漏到椎间盘,无椎管内渗漏发生,均未产生临床症状。骨水泥渗漏发生率GenantⅠ型较GenantⅡ、Ⅲ型低,差异有统计学意义(P<0.05)。结论体位复位PVP治疗骨质疏松性椎体压缩骨折能有效减轻患者疼痛,明显改善GenantⅡ、Ⅲ型椎体压缩骨折的伤椎前缘高度比及后凸角,但随着椎体压缩程度的增加,骨水泥渗漏风险增高。     

PI-3K信号通路在吗啡依赖纳洛酮激发戒断反应中的作用

目的：研究PI-3K信号通路在吗啡依赖纳洛酮激发戒断反应中的作用。方法：在小鼠急性和慢性吗啡依赖和戒断模型上，采用鞘内和脑室内注射PI-3K抑制剂对吗啡依赖小鼠纳洛酮催促戒断反应的影响，探讨神经元PI-3K信号通路吗啡依赖和戒断过程中的作用。结果：鞘内预先注射PI-3K信号通路抑制剂LY294002及Wortmanin能明显加重急性和慢性吗啡依赖小鼠纳洛酮激发戒断反应。脑窜内预先注射PI-3K信号通路抑制剂LY294002及Wortmanin也明显加重急性和慢性吗啡依赖小鼠纳洛酮激发戒断反应。结论：脊髓和脊髓上中枢神经元PI-3K信号通路均参与吗啡依赖的形成及戒断反应的表达。     

Bariatric surgery improves metabolic and nonalcoholic fatty liver disease markers in metabolically healthy patients with morbid obesity at 5 years

BackgroundNo studies have evaluated the effect of metabolic and bariatric surgery (MBS) on nonalcoholic fatty liver disease (NAFLD) and cardiometabolic markers in metabolically healthy patients with morbid obesity (MHMO) at midterm.ObjectivesTo assess the effect of MBS on NAFLD and cardiometabolic markers in MHMO patients and ascertain whether metabolically unhealthy patients with morbid obesity (MUMO) remain metabolically healthy at 5 years after MBS.SettingUniversity hospital.MethodsA total of 191 patients with a body mass index >40 kg/m² and at least 5 years of follow-up were retrospectively analyzed. Lost to follow-up were 37.6% (151 of 401 patients). Patients were classified as MHMO if 1 or 0 of the cardiometabolic markers were present using the Wildman criteria. The degree of liver fibrosis was assessed using the NAFLD fibrosis score (NFS).ResultsForty-one patients (21.5%) fulfilled the criteria for MHMO. They showed significant improvements in blood pressure (from 135.1 ± 22.1 and 84.2 ± 14.3 mm Hg to 117.7 ± 19.2 and 73.0 ± 10.9 mm Hg), plasma glucose (from 91.0 ± 5.6 mg/dL to 87.2 ± 5.2 mg/dL), homeostatic model assessment for insulin resistance (from 2.2 ± .9 to 1.0 ± .8), triglycerides (from 88.0 [range, 79.5–103.5] mg/dL to 61.0 [range, 2.0–76.5] mg/dL), alanine aminotransferase, gamma-glutamyl transpeptidase NFS (from −1.0 ± 1.0 to −1.9 ± 1.2), and high-density lipoprotein cholesterol (from 56.9 ± 10.5 mg/dL to 77.9 ± 17.4 mg/dL) at 5 years after surgery. A total of 108 MUMO patients (84.4%) who became metabolically healthy after 1 year stayed healthy at 5 years.ConclusionsMBS induced a midterm improvement in cardiometabolic and NAFLD markers in MHMO patients. Seventy-six percent of MUMO patients became metabolically healthy at 5 years after MBS.     

The veiled intimacy between neurology and Vincent van Gogh

Vincent van Gogh (1853–1890) is one of the most important painters of our history. Celebrating 130 years since the death of this genius, this article unveils the surprising relationship between van Gogh and neurology. Besides all his eternal artistic output, Vincent also suffered all his life from a neurological disease. Many articles have already investigated his illness and epilepsy appears to be one of the most reasonable diagnosis. There is much evidence that van Gogh's work was influenced by his neurological condition in several ways. Besides, the analysis of Vincent's life can provide several valuable teachings to neurologists.     

后腹腔镜输尿管切开取石治疗嵌顿性输尿管下段结石伴感染的临床体会

目的探讨后腹腔镜输尿管切开取石治疗嵌顿性输尿管下段结石伴有感染的安全性、有效性及实用性。方法回顾性分析2017年6月至2019年6月我科收治的6例诊断为嵌顿性输尿管下段结石伴有感染的病例资料,其中4例术前行体外冲击波碎石术(ESWL)治疗失败,2例术前尿培养阳性且伴有发热,尿常规WBC均为++~+++,均采用后腹腔镜下输尿管下段结石切开取石术,记录其手术时间、术后肠功能恢复时间、总住院天数及相关并发症。结果6例患者行经腹膜后腹腔镜下输尿管下段结石切开取石术均获得成功,无一例中转经腹入路腹腔镜下输尿管切开取石或开放手术。手术时间为55~100 min(平均82.5 min);术后肠功能恢复时间为1~2 d(平均1.7 d),总住院时间7~13 d(平均8.5 d)。其中1例术后拔除尿管后出现腰痛、发热,考虑为前列腺增生、尿潴留、尿液返流所致尿外渗,予保留导尿后症状消失。随访时间3~12个月,均无结石复发、输尿管狭窄等严重并发症。结论经后腹腔入路腹腔镜输尿管下段切开取石术安全可行,创伤小、恢复快,尤其适用于伴感染的输尿管结石患者,值得临床推广,但对术者的腹膜后解剖及腔镜技术提出了更高要求。     

Preoperative neutrophil-to-lymphocyte ratio is a more valuable prognostic factor than platelet-to-lymphocyte ratio for nonmetastatic rectal cancer

Several combinations of inflammatory factors, including neutrophil-to- lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), have been reported to be prognostic factors in various malignant tumors, including colorectal cancer (CRC). The aim of this study was to evaluate the prognostic value of NLR and PLR for patients with rectal cancer (RC) who underwent curative surgery. Data from patients who underwent curative resection for RC were retrospectively reviewed. The cutoff for NLR and PLR was defined as 2.3 and 144 by receiver operating characteristic (ROC) curve. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier method. Multivariable Cox regression model was used to evaluate the independent prognostic significance of variables. A total of 140 patients were eligible in the study. High NLR (> 2.3) and high PLR (> 144) both predicted lower OS and DFS according to Kaplan-Meier method. But in the multivariable Cox regression model, only the high NLR retained significance for reduced OS and DFS. According to Chi-square test, patients with higher NLR had larger tumor size and higher pN-stage. While PLR was only associated with the pN-stage. High preoperative NLR was shown to be a negative independent prognostic factor in patients undergoing resection for nonmetastatic RC. It may be helpful as a factor to guide the postoperative therapies.