基于“肝阳虚”理论探讨化疗所致周围神经病变的病机与治疗＊

化疗所致周围神经病变（Chemotherapy-induced peripheral neuropathy，CIPN）是临床常见的由化疗药物引起的一系列神经毒性症状，易造成神经功能障碍，四肢感觉弱化、缺失等，严重影响肿瘤患者生活质量及临床疗效。CIPN的发病机制尚不十分明确，目前也没有可广泛用于临床的特效药物治疗。中医药治疗CIPN具有特定的优势，取得了一定成绩，但在理论依据和临床疗效方面仍有一定的局限性。本文通过分析CIPN的临床症状特点，深入剖析其与中医肝阳虚理论之间的关系，探讨CIPN的中医病因病机与用药规律，指导临床治疗CIPN，以期更好地发挥中医药在肿瘤治疗中的减毒增效作用。     

Comparative Outcome Analysis of N-Butyl Cyanoacrylate Embolization of the False Lumen Versus Thoracic Endovascular Aortic Repair in Aortic Dissection

PurposeTo evaluate the feasibility, safety, and effectiveness of N-butyl cyanoacrylate (NBCA) embolization for the treatment of aortic dissection.Materials and MethodsIn this single-center retrospective study conducted from February 2003 to June 2019, NBCA embolization of an aortic false lumen was attempted in 12 patients (median age, 59 y; range, 41–68 y) and thoracic endovascular aortic repair (TEVAR) was performed in 53 patients (median age, 59 y; range, 37–70 y) for aortic dissection with one or more indications of persisting pain, malperfusion, rupture or impending rupture, maximal aortic diameter ≥ 55 mm, and/or rapid aortic enlargement. The main exclusion criterion for embolization was the presence of fast blood flow in the aortic false lumen on aortography. The efficacy of NBCA embolization and TEVAR was compared by evaluating technical and clinical outcomes, repeat intervention–free survival (RFS), and overall survival (OS).ResultsTechnical success was achieved in 11 of the 12 patients treated with NBCA embolization (91.7%), and clinical success was achieved in 9 of these 11 (81.8%). No significant difference was found between embolization and TEVAR in clinical success rates (embolization, 81.8%; TEVAR, 84.9%; P = .409) or procedure-related complications (embolization, 1 patient [8.3%]; TEVAR, 4 patients [7.5%]; P = .701). In addition, embolization showed comparable 5-y RFS (embolization, 82.5% ± 9.3; TEVAR, 85.5% ± 4.8; P = .641) and 5-y OS (embolization, 100%; TEVAR, 95.4% ± 3.2; P = .744) rates to TEVAR.ConclusionsNBCA embolization of the false lumen in aortic dissection seems to be a safe and effective treatment modality for the closure of false lumen in selected patients.     

Visual fixations and visually induced dizziness: An exploratory study

BackgroundVisually induced dizziness can develop as a sequala of a vestibular disorder and is characterized by symptoms of nausea, dizziness, and imbalance in rich visual environments such as supermarkets and shopping malls. To date the mechanisms underlying visually induced dizziness are poorly understood.Research questionWhat are the characteristics of visual fixations and postural sway in adults with visually induced dizziness compared to healthy adults when exposed to increasingly complex visual environments?MethodsWe recruited 20 adults with visually induced dizziness and 20 healthy adults to this cross-sectional exploratory study. Participants were instructed to maintain gaze on letters projected on a large screen with backgrounds of differing visual complexity. The number of visual refixations, movement of the centre of pressure, and movement of the head and body centres of mass were recorded.ResultsAdults with visually induced dizziness showed a significantly higher number of visual refixations (F= 10.592, p < 0.01), and increased mean velocity of head and body centres of mass movement (F= 14.034, p < 0.01 and F= 6.553, p < 0.05 respectively) compared to healthy adults.SignificanceAdults with visually induced dizziness exhibited visual fixational instability and increased postural and head sway compared to healthy adults. This was mainly observed in conditions with complex and moving backgrounds. This may account for reports from adults with visually induced dizziness of worsening symptoms in busy environments. The results from the study may assist in guiding intervention development to reduce symptoms of visually induced dizziness.     

Insights into the pathogenesis of ATP1A1‐related CMT disease using patient‐specific iPSCs

The development of patient‐specific induced pluripotent stem cells (iPSCs) offered interesting insights in modeling the pathogenesis of Charcot‐Marie‐Tooth (CMT) disease and thus we decided to explore the phenotypes of iPSCs derived from a single CMT patient carrying a mutant ATP1A1 allele (p.Pro600Ala). iPSCs clones generated from CMT and control fibroblasts, were induced to differentiate into neural precursors and then into post‐mitotic neurons. Control iPSCs differentiated into neuronal precursors and then into post‐mitotic neurons within 6‐8 days. On the contrary, the differentiation of CMT iPSCs was clearly defective. Electrophysiological properties confirmed that post‐mitotic neurons were less mature compared to the normal counterpart. The impairment of in vitro differentiation of CMT iPSCs only concerned with the neuronal pathway, because they were able to differentiate into mesendodermal cells and other ectodermal derivatives. ATP1A1 was undetectable in the few neuronal cells derived from CMT iPSCs. ATP1A1 gene mutation (p.Pro600Ala), responsible for a form of axonal CMT disease, is associated in vitro with a dramatic alteration of the differentiation of patient‐derived iPSCs into post‐mitotic neurons. Thus, the defect in neuronal cell development might lead in vivo to a decreased number of mature neurons in ATP1A1‐CMT disease.     

Positive HLA‐B27 and sacroiliitis is not always spondyloarthritis

A 36‐year‐old man was treated for several years with multiple agents for ankylosing spondylitis based on positive human leukocyte antigen‐B27 and sacroiliitis. He was also diagnosed with osteoporosis and hypophosphatemia. Over these years, from being an avid runner, he became dependent on a walker for ambulation. The lack of treatment response and the low phosphorus were clues that eventually led to a diagnosis of tumor‐induced osteomalacia. This case discusses the importance of not solely relying on genetic markers and sacroiliitis for diagnosing ankylosing spondylitis as other conditions can cause similar presentations.     

Mimengosides J and K: two new neuroprotective triterpenoids from the fruits of Buddleja lindleyana

Two new 11-methoxyl substituted triterpenoids, named as mimengosides J (1) and K (2), along with seven known compounds, were isolated from the fruits of Buddleja lindleyana. Their structures were elucidated on the basis of spectroscopic analysis. In addition, the new ones were evaluated for protective effects against damage of SH-SY5Y cells induced by 1-methyl-4-phenylpyridinium ion (MPP⁺) and the results indicated that those may be one of the candidate compositions of Buddleja lindleyana for the treatment of neurodegenerative disease.