A fatal case of Degos' disease which presented with recurrent intestinal perforation

Degos’ disease,otherwise known as "malignant atrophic papulosis" is a rare vasculopathy with an unknown etiology characterized by typical cutaneous lesions.Involvement of the gastrointestinal(GI) tract is observed in approximately half of patients and small infarctions in the mucosa can cause perforation and resulting peritonitis,the leading cause of death.We present a fatal case of Degos’ disease with skin and GI involvement,manifesting as recurrent intestinal perforations and peritonitis,in a 15-year-old Iranian boy.     

Criculating fibrocytes: a potent cell population in antigen-presenting and wound healing

Fibrocytes are bone marrow-derived mesenchymal progenitors that co-express hematopoietic cell antigens and markers of monocytic lineage as well as fibroblast products. During wound healing, fibrocytes have been found to possess the ability of antigen-presentation to naive T cells in the inflammatory phase. Moreover, they can promote the endothelial cell proliferation, migration and angiogenesis by secreting several proteins. Fibrocytes can further differentiate into mature mesenchymocyte lineage, such as fibroblasts, myofibroblasts and adipocytes, and they may represent the systemic source of myofibroblasts that exert a contractile force required to close tissue wounds. A deep understanding of the mechanism involved in fibrocyte migration and differentiation may lead to the development of a novel theory of normal physiology and pathology.     

Metformin revisited: Does this regulator of AMP-activated protein kinase secondarily affect bone metabolism and prevent diabetic osteopathy?

Patients with long-term type 1 and type 2 diabetes mellitus(DM) can develop skeletal complications or “diabetic osteopathy”. These include osteopenia, osteoporosis and an increased incidence of low-stress fractures. In this context, it is important to evaluate whether current anti-diabetic treatments can secondarily affect bone metabolism. Adenosine monophosphateactivated protein kinase(AMPK) modulates multiple metabolic pathways and acts as a sensor of the cellular energy status; recent evidence suggests a critical role for AMPK in bone homeostasis. In addition, AMPK activation is believed to mediate most clinical effects of the insulin-sensitizer metformin. Over the past decade, several research groups have investigated the effects of metformin on bone, providing a considerable body of pre-clinical(in vitro, ex vivo and in vivo) as well as clinical evidence for an anabolic action of metformin on bone. However, two caveats should be kept in mind when considering metformin treatment for a patient with type 2 DM at risk for diabetic osteopathy. In the first place, metformin should probably not be considered an antiosteoporotic drug; it is an insulin sensitizer with proven macrovascular benefits that can secondarily improve bone metabolism in the context of DM. Secondly, we are still awaiting the results of randomized placebo-controlled studies in humans that evaluate the effects of metformin on bone metabolism as a primary endpoint.     

Near-infrared fluorescence imaging of a solitary fibrous tumor of the pancreas using methylene blue

A 67-year-old female presented with unexplained abdominal pain. A contrast-enhanced computed tomography scan of the abdomen incidentally revealed a mass in the uncinate process of the pancreas. This mass was resected and based on histopathological findings, diagnosed as a solitary fibrous tumor (SFT) of the pancreas. A SFT is an extremely rare benign mesenchymal tumor that in 65% of cases affects the visceral pleura but can also affect extra-pleural sites. The intraoperative demarcation of pancreatic tumors, such as SFTs, can bechallenging. In this report, the first clear intraoperative identification of a SFT of the pancreas in a human was shown using near-infrared fluorescence and methylene blue.     

Prospets of stem cell research and regeneration medicine

Since the new century,stem cell research has become a hot field in medicine and life science.Scientists in Harvard Plans Stem Cell Center in 2004 have dreamed that one day they can lead stem cells to grow into tissues and even organs in the lab,which can be used to replace the damaged tissues or organs in severe injuries or applied in diseases at the end stage(incurable diseases)in order to prolong the life time and improve the life quality of patients.But this is a long way full of difficulties! Nevertheless,the stem cell research has helped our mankind to understand how single cells grow and develop into tissues as well as organs,and how healthy cells replace the damaged cells in adult body and so on,which induces us to explore the way of treating diseases on cell levels(repairing or regeneration medicine as we usually say)because gene therapies have many unsolved problems.     

Diabetes and cognitive function: An evidence-based current perspective

Several epidemiological studies have clearly identified diabetes mellitus(DM) as a major risk factor for cognitive dysfunction, and it is going to be a major public health issue in the coming years because of the alarming rise in diabetes prevalence across the world. Brain and neural tissues predominantly depend on glucose as energy substrate and hence, any alterations in carbohydrate metabolism can directly impact on cerebral functional output including cognition, executive capacity, and memory...     

What Is the Future of Swan-Ganz Catheter？

The pulmonary arterial catheter （PAC）, also known as the Swan-Ganz catheter, was introduced in 1970 for clinical use. It can be placed in the operating room or intensive care unit （ICU） within a few minutes even in critically ill patients. Although placement of these catheters is not difficult, some training and experience are required to avoid complications and for proper interpretation of the hemodynamic data that can be obtained by PAC. Because of the many advantages of this catheter, they have been used without a proper indication and frequently overused in operating rooms and ICUs, resulting in many complications, including mortality.     

Can inhibin-B predict the outcome of microsurgical epididymal sperm aspiration in patients with suspected primary obstructive azoospermia？

Aim： To evaluate whether inhibin-B can predict the outcome of a microsurgical epidymal sperm aspiration （MESA） procedure in patients with suspected primary obstructive azoospermia （OA） and if inhibin-B can replace testicular biopsy in the diagnostic work-up of these patients. Methods： Inhibin-B levels and testicular biopsy scores were related to the outcome of MESA in 43 patients with suspected primary OA. MESA was considered to be successful when epididymal sperm could be identified during the procedure. Results： Spermatozoa were present in the epididymal aspirate in 28 out of the 43 patients （65%）. lnhibin-B values were not significantly different in patients with successful or unsuccessful MESA. The modified Johnsen score, however, was significantly lower in patients with unsuccessful MESA （P = 0.003）. A rete testis obstruction or epididymal malfunctioning was found in 15% of patients with suspected primary OA, reflected by unsuccessful MESA despite normal inhibin-B levels and normal testicular histology. Conclusion： Inhibin-B cannot replace testicular biopsy as a diagnostic tool in the work-up of patients with suspected primary OA. Testicular biopsy is useful in identifying patients with spermatogenic arrest, who might have normal inhibin-B values.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

乳化异氟烷器官保护作用研究进展

Background Emulsified isoflurane (EI) is a new type of anesthetic which is still not clinically available. It consists of isoflurane and 30% of fat emulsion as carrier, which can provide good anesthetic effect. Both in vitro and in vivo animal studies have demonstrated that pre-or post-conditioning with EI can produce protective effects for many organs. Purpose To review organ protective effects and the mechanisms of pre- or post-conditioning with EI. Content It is demonstrated that, both in vitro and in vivo animal studies, pre- or post-conditioning with EI can produce protective effects on heart, lung, brain and liver from ischemia reperfusion injuries within a certain range of concentration. And it is supposed that these effects are resulted from isoflurane itself. The mechanisms involve the activation of ATP-sensitive potassium channels, inhibition of NF-κB activation, inhibition of apoptosis and anti-oxidation, etc. Trend As a new intravenous formulation, EI will have a better clinical application for vital organs protection. But all the studies at present only focused on animal experiments, much more further studies need to be done before it can be applied in the clinic.     

“外科格言与引语”集萃(二)

Prophylactic antibiotics will turn a third class surgeon into a second class but will never turn a second class surgeon into the first class one.预防性使用抗菌药物能把三等外科医师变成二等,但决无可能把二等外科医师变成一等。——Owen H.Wangensteen,1898—1981。The greatest boom to surgeryfs advance in this century has been control of cellulitic infections through chemotherapeutic agencies,the sulfonamides and antibiotics.When will surgery experience another great catalytic forward thrust like that achieved through anesthesia,prophylactic antisepsis,and the antibiotics?通过化疗制剂、磺胺和抗菌药物来控制蜂窝组织炎一直是本世纪最热门的外科进展事件。外科何时能再经历另一场像麻醉、预防性消毒和抗菌药物发现这样伟大的具有催化作用的推进呢?——Owen H.Wangensteen,1898—1981。     

Anterior knee pain after a total knee arthroplasty: What can cause this pain?

Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis,and yet approximately 5%-10%of patients experience residual pain,especially in the anterior part of the knee.Many theories have been proposed to explain the etiology of this anterior knee pain(AKP)but,despite improvements having been made,AKP remains a problem.AKP can be described as retropatellar or peripatellar pain,which limits patients in their everyday lives.Patients suffering from AKP experience difficulty in standing up from a chair,walking up and down stairs and riding a bicycle.The question asked was:"How can a‘perfectly’placed total knee arthroplasty(TKA)still be painful:what can cause this pain?".To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain.Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA.This article is a review of what pain is,how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty.     

The Asian Journal of Andrology： view of an outsider coming in

My interest in science in China, .stimulated in 1980 by reading theabridged version of Joseph Needham＇s ＂Science and Civilization in China＂, continued when I was a Consultant to the National Family Planning Research Institute in Beijing in 1983, and to the Shandong Stem Cell Engineering Research Center, Yantai in 2009-2012. During that time, I have acted as reviewer of the Asian Journal of Andrology （AJA）, and I continue to be one of its editorial board members. What I can contribute as the second Deputy Editor-in-Chief for the journal will depend on the challenges faced by the journal in the coming years.     

Inhibition of fibroblast activation protein ameliorates cartilage matrix degradation and osteoarthritis progression

Fibroblast activation protein(Fap) is a serine protease that degrades denatured type I collagen, α2-antiplasmin and FGF21. Fap is highly expressed in bone marrow stromal cells and functions as an osteogenic suppressor and can be inhibited by the bone growth factor Osteolectin(Oln). Fap is also expressed in synovial fibroblasts and positively correlated with the severity of rheumatoid arthritis(RA). However, whether Fap plays a critical role in osteoarthritis(OA) remains poorly understood. Here, ...     

Statin use and risk of diabetes mellitus

The 3-hydroxy-methylglutaryl coenzyme A reductase inhibitors, statins, are widely used in the primary and secondary prevention of cardiovascular diseases to lower serum cholesterol levels. As type 2 diabetes mellitus is accompanied by dyslipidemia, statins have a major role in preventing the long term complications in diabetes and are recommended for diabetics with normal low density lipoprotein levels as well. In 2012, United States Food and Drug Administration released changes to statin safety label to include that statins have been found to increase glycosylated haemoglobin and fasting serum glucose levels. Many studies done on patients with cardiovascular risk factors have shown that statins have diabetogenic potential and the effect varies as per the dosage and type used. The various mechanisms for this effect have been proposed and one of them is downregulation of glucose transporters by the statins. The recommendations by the investigators are that though statins can have diabetogenic risk, they have more long term benefits which can outweigh the risk. In elderly patients and those with metabolic syndrome, as the risk of diabetes increase, the statins should be used cautiously. Other than a subset of population with risk for diabetes; statins still have long term survival benefits in most of the patients.     

Rise and fall of anti-obesity drugs

Although it is not generally a life-threatening disease,obesity is becoming a major health problem worldwide.It can be controlled by means of drugs,and,consequently,these are required to be safe as well as effective.In this paper,we summarize the fate of various drugs that have been introduced for clinical use in the treatment of obesity.Fenfluramine and dexfenfluramine were withdrawn because of heart valve damage.Sibutramine suppresses appetite and increases heart rate and blood pressure.In the Sibutramine Cardiovascular OUTcomes trial,an increase in major adverse cardiovascular events prompted its withdrawal in Europe and the United States.Rimonabant is an endocannabinoid receptor antagonist that reduces body weight and ameliorates some cardiovascular risk factors.However,adverse psychiatric side effects led to its withdrawal as well.Orlistat is approved in Europe and the United States for the treatment of obesity,but its use is limited by gastrointestinal side-effects.Ephedrine and caffeine are natural ingredients in foods and supplements that may help the person to lose weight.In the light of several failed attempts,there is a clear need to develop drugs that are effective and safe in the long term in order to successfully combat the phenomenon of obesity.     

Anti-infective reconstituted bone xenograft used for primary bone grafting to repair contaminated defect in the radius in dogs

Objective: To investigate the effect of anti-infective reconstituted bone xenograft as a primary graft to repair a segmental with severe contamination. Methods: A canine model of contaminated defect of 1.5 cm in size in the radius was used, in which antiinfective reconstituted bone xenograft or reconstituted bone xenograft was implanted as a primary graft followed by internal fixation. The effectiveness of the two grafting materials in repairing a contaminated segmental defect was compared. Resuits: The animals which had received implant of anti-infective reconstituted bone xenograft should largely healed defects 6 months after operation while the defects implanted wit]h reconstituted bone xenograft remained unrepaired witla bone infection. Conclusions: Besides its strong osteoinductive and osteoconductive activity, anti-infective reconstituted bone xenograft is highly antibacterial and can be used as a primary graft to repair the severely contaminated segmental defect.     

Male circumcision： towards a World Health Organisation normative practice in resource limited settings

There is now grade 1 evidence that male circumcision （MC） reduces the risk of a man acquiring HIV. Modelling studies indicate MC could in the next 10 years save up to 2 million lives in those African countries with high HIV prevalence. Several African countries are now scaling up public health MC programmes. The most effective immediate public health MC programmes in Africa will need to target 18-20 years old men. In the longer term there is a need for infant circumcision programmes. In order to implement more widespread MC there is a need to make the surgical procedures as simple as possible so that safe operations can be performed by paramedical staff. The WHO Manual of Male Circumcision under local anaesthetic was written with these objectives in mind. Included in the manual are three adult techniques and four paediatric procedures. The adult procedures are the dorsal slit, the for- ceps guided and the sleeve resection methods. Paediatric methods included are the plastibell technique, the Mogen and Gomco shield method and a standard surgical dorsal slit procedure. Each method is described in a step by step manner with photographic and line drawing illustrations. In addition to the WHO manual of surgical technique a teaching course has been developed and using this course it has been possible in one week to train a circumcision surgeon who has had no or minimal previous surgical experience. Further scaling will require training of circumcision surgeons, monitoring performance, training the trainer workshops as well as advocacy at national, international and government meetings. In addition to proceeding with standardised methods work is in progress to assess novel techniques in adults such as stay on ring devices and policies are being formulated as to how to assess new devices. Also work is in progress to explore efficiencies in surgical processing by task sharing. Proper informed consent and safety remain paramount and great care has to be taken as programmes in Africa scale up. In continental China where the HIV epidemic is at a much earlier stage there may be a case for considering infant circumcision but great care will be needed to ensure that there is no harm.