Type IX Ehlers-Danlos syndrome. A new variant with pathognomonic radiographic features

The authors describe 7 male patients from two unrelated families who presented with what appears to be a heretofore undiagnosed X-linked variant of Ehlers-Danlos syndrome. Unlike the eight previously reported types, this variant is manifested by specific skeletal abnormalities, including occipital exostoses, widening and bowing of multiple long bones at tendinous and ligamentous insertion sites, and deformed clavicles. Major clinical complications include genitourinary problems, chronic diarrhea with malabsorption, and/or syncopal episodes. Laboratory tests suggest that this variant may represent the true lysyl-oxidase-deficient form of Ehlers-Danlos syndrome.     

Carbon dioxide as a lighter-than-urine contrast medium for percutaneous nephrostomy

Carbon dioxide was used either alone or in combination with standard triiodinated contrast media in 32 patients who underwent percutaneous nephrostomy. Carbon dioxide was used to opacify the posterior calyces, which are the uppermost structures in the kidney of the prone or prone-oblique patient. Carbon dioxide is usually injected in small amounts (20-40 cm3), although clinical and laboratory data indicate that it can be used as the only medium in large amounts with complete safety. There were no complications.     

干细胞因子基因cDNA克隆及其在造血干细胞中的表达

目的:克隆人干细胞因子基因cDNA,构建真核表达载体并转导脐带血造血干细胞,观察干细胞因子在造血干细胞中的表达,从而为脐血造血干细胞扩增及移植奠定实验基础。方法:实验于2005-09/12在承德医学院基础医学研究所和湖南师范大学医学院寄生虫病研究室完成。①实验材料:健康胎儿脐带由承德医学院附属医院提供,产妇均签署知情同意书;pcDNA3.1.大肠杆菌E.coliDH5α由本室保存;pUCm-T vector (promega公司);BamHⅠ,XbaⅠ(New England BioLabs公司):②实验方法:无菌收集胎儿脐带,胶原酶 胰蛋白酶 乙二胺四乙酸联合消化,分离培养人脐带内皮细胞。从上述含脐带内皮细胞的培养液中分离提取干细胞因子mRNA,用反转录-聚合酶链反应扩增干细胞因子cDNA.纯化的PCR产物与载体pUCm-T加入连接反应体系,构建及克隆pUCm-T/SCF质粒,其与pcDNA3.1分别进行BamHⅠ、XbaⅠ双酶切反应,产物经琼脂糖凝胶电泳后回收干细胞因子cDNA和pcDNA3.1片段,构建真核表达型载体pcDNA3.1/SCF。以密度梯度法 免疫磁珠法分离收集人脐血CD34~ 造血干细胞.导入pcDNA3.1/SCF,设立未转导对照组。③实验评估:转导后1～7 d检测两组细胞上清液中干细胞因子水平的表达。结果:①人于细胞因子基因cDNA克隆:扩增的人干细胞因子基因cDNA理论上应为690 bp,实际PCR产物经琼脂糖凝胶电泳后,紫外线下可见-预期大小的条带,证明干细胞因子mRNA提取成功,反转录合成的cDNA完整。②分泌型真核表达质粒pcDNA3.1/SCF的构建:BamHⅠ和XbaⅠ双酶切后电泳可见690 bp的插入片段,与干细胞因子基因序列相同,表明分泌型真核表达质粒pcDNA3.1/SCF构建成功。③脐血造血干细胞培养上清中的干细胞因子水平:培养第1～7天.转导pcDNA3.1/SCF的脐血造血干细胞上清中的干细胞因子表达水平均明显高于未转导对照组(P<0.01)。结论:成功克隆人干细胞因子基因cDNA,并构建了重组质粒pcDNA3.1/SCF,该质粒转导脐血造血干细胞后.能在短期内有效表达。     

Leukopenic chronic T cell leukemia mimicking hairy cell leukemia: association with human retroviruses

We report two cases of a T cell lymphoproliferative disease not previously described, with cytologic and clinical features similar to those associated with Galton's "prolymphocytic" leukemia (PL). Our patients, like those with Galton's PL, had massive splenomegaly and minimal or absent hepatomegaly and lymphadenopathy. In contrast, however, our patients had leukopenia, as well as low percentages of leukemic cells in the peripheral blood and in the bone marrow. In splenic imprints, the nuclear chromatin pattern of most of the leukemic cells was intermediate between those of mature lymphocytes and those of lymphoblasts, and the nuclei contained single, centrally located, conspicuous nucleoli. In sections of the spleen, the leukemic cells diffusely infiltrated the red pulp in a pattern strikingly similar to that of hairy cell leukemia; however, when the leukemic cells were studied cytochemically, the cytoplasmic acid phosphatase positivity was punctate and tartrate-sensitive. The leukemic cells were sheep erythrocyte rosette-positive and expressed T cell-associated antigens. Initially, both patients responded well to therapeutic splenectomy. One patient received combination chemotherapy after splenectomy and is alive and well 24 months after diagnosis. The other patient was in complete clinical remission for one year after splenectomy and received chemotherapy at relapse. He died, however, 23 months after splenectomy, with disseminated disease. IgG antibody titers against human T lymphotropic virus type I (HTLV-I) were detected in one patient and against HTLV-II in the other. The leukemia in these patients represents a distinct clinicopathologic entity within the spectrum of peripheral T cell lymphoproliferative diseases that includes Galton's PL of T cell derivation, T cell chronic lymphocytic leukemia, T cell hairy cell leukemia, and adult T cell leukemia/lymphoma.     

Assessing basophil functional measures during monoclonal anti-IgE therapy

Assessing the impact of therapeutic interventions on the clinical and immunologic responses of allergic subjects is a topic of extensive investigation. Available approaches include the measurement of in vivo allergen challenge responses, serologic measures, or in vitro studies of cells that participate in the allergic reaction. Several decades of work support that measures of allergen responses of IgE-bearing peripheral blood basophils can reflect clinical expression of allergic disease. In the last decade, an immune-based therapy targeting IgE, omalizumab, has emerged as an adjunct treatment for a variety of allergic diseases. This monoclonal humanized IgG antibody specifically binds circulating IgE at a region in the Fc tail that prevents IgE attachment to high affinity IgE receptor (FcεRI) bearing cell types such as tissue mast cells and blood basophils. This review focuses on methods to monitor changes of basophil allergen reactivity with a focus on omalizumab therapy and the implications for clinical disease management.     

单用静脉大豆油脂肪乳剂对比联合应用鱼油脂肪乳剂的肠外营养对消化道肿瘤术后患者结局影响的随机、对照、双盲、多中心临床研究(摘要)

部分回顾性临床研究观察到在营养液配方中添加特异的药理营养素可能降低术后并发症,缩短术后恢复时间,但仍缺乏较大样本、前瞻性、多中心、随机对照临床研究的证据.近年来,药理营养素在肿瘤患者综合治疗中可能发挥的作用逐渐受到重视.本研究前瞻性观察了静脉用鱼油脂肪乳剂对消化道肿瘤术后患者结局和免疫功能的影响.     

期刊俱乐部和病例讨论会改变医生临床实践的效果

作为互动性很强的小组学习形式,目前还不清楚期刊俱乐部和病例讨论会形式的继续医学教育活动是否能与传统的继续医学教育活动一样,帮助医生改变临床实践水平.为此,美国科罗拉多医疗公司进行了一项观察性研究,以确定期刊俱乐部和病例讨论会形式的继续医学教育活动的效果.     

新型输送型球囊扩张导管在颅内动脉狭窄治疗中的临床应用研究

目的：探讨新型输送型球囊扩张导管(Fastunnel)在颅内动脉粥样硬化狭窄介入治疗中的应用效果。方法：2021年11月至2022年2月,我们使用新型输送型球囊扩张导管对10例颅内动脉粥样硬化狭窄的患者进行了球囊扩张+支架成形术。收集并分析了患者的基线情况、影像学特点、治疗情况及围手术期情况。结果：男6例,女性4例,平均年龄(62.7±6.7)岁。10例患者均成功接受手术治疗,手术时长为16~65(37.3±18.2)min,治疗过程所受辐射剂量为1381~4901(2643.7±1131.7)mGy,剂量面积乘积(DAP)值为5707~38112(17526.8±10809.5)μGym₂^。围手术期无出血及缺血相关并发症。结论：输送型球囊扩张导管具有较好的安全性,能有效地简化手术步骤、缩短手术时间,对减少患者及医生所受射线剂量。