儿童急性播散性脑脊髓炎3例报告

急性播散性脑脊髓炎(acute disseminated encephalomyelitis,ADEM)是一种广泛累及中枢神经系统(脑和脊髓)白质的急性炎性反应,以非对称多灶性或弥漫性脱髓鞘病灶为主要病理特征.ADEM临床表现多样,呈急性或亚急性起病,是儿童最常见的获得性脑白质病.本研究总结分析了3例昆明医科大学第一附属医院收治的ADEM患儿的临床特点、辅助检查、治疗、预后等资料,以期提高对ADEM的认识,现报告如下.     

Differential expression of two genes Oct‐4 and MUC5AC associates with poor outcome in patients with gastric cancer

Gastric cancer (GC) is the most frequent leading cause of cancer‐associated mortality worldwide that is linked to poor prognosis due to the lack of appropriate biomarkers. Our aim was to evaluate the MUC5AC and Oct‐4 expression levels in GC and to assess their association with clinical factors. Immunohistochemical analysis (IHC) and qRT‐PCR were performed in GC patients to examine the MUC5AC and Oct‐4 expression levels. The mRNA level of MUC5AC was significantly decreased in tumour tissues compared with non‐cancerous tissues (1.11 ± 0.69 vs 3.7 ± 0.71; P = .024). On the other hand, Oct‐4 mRNA level was upregulated in tumour tissues as compared to normal tissues (2. 86 ± 0.78 vs 0.87 ± 0.54; P = .0015). Decreased expression of MUC5AC was detected in 27 patients (67.5%), while high to moderate expression levels were observed in 13 cases (32.5%), but in normal tissues the expression levels of MUC5AC were increased (P = .001). The decreased expression of MUC5AC was associated with aggressive tumour characteristics, such as TNM stage (P = .023), histologic type (P = .012) and lymph node metastasis (P = .001). High expression of Oct‐4 was detected in 24 tumour tissues (60%), while 16 cases (40%) showed low expression level. Increased Oct‐4 expression was correlated with clinicopathological characteristics such TNM stage (P = .002), histologic type (P = .008) and lymph node metastasis (P = .001). Our results showed that high Oct‐4 expression and the reduction of MUC5AC expression may be involved in the progression and an unfavorable prognosis of GC.     

Onychomadesis in a 9-month-old boy with hand-foot-mouth disease

Background

Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis is described as a rare, late complication of hand-foot-mouth disease, which is a viral illness commonly seen in the pediatric age group. It is therefore important to elucidate the presentation of this entity, especially in the context of the hand-foot-mouth disease.

Case presentation

We report a case of onychomadesis in a 9-month old Lebanese boy who presented to the emergency department with rapidly progressing nail changes involving all four extremities. These changes appeared few days after the healing of cutaneous lesions of hand-foot-mouth disease.

Conclusions

This case highlights the importance of recognizing the association between onychomadesis and hand-foot-mouth disease in order to avoid unnecessary treatment and to reassure the patient’s parents.

     

Cost‐effectiveness of aftercare services for people with severe mental disorders: an analysis parallel to a randomised controlled clinical trial in Iran

Aftercare services are not part of the usual care for people with severe mental disorders in Iran. This study was performed to assess the cost‐effectiveness of aftercare services, including telephone follow‐up or home visit, in addition to caregivers’ education and training of social skills, for all subjects during the 20 months after hospital discharge. An economic evaluation was performed along with a registered randomised controlled trial (IRCT201009052557N2) on two groups of 60 persons recruited between 2010 and 2012. Intervention's effectiveness was measured by psychopathology and quality of life indicators. Cost‐effectiveness and cost‐utility were analysed from the societal and Ministry of Health (MoH) perspectives. All indicators of psychopathology, quality of life and satisfaction with services in the intervention group were significantly different from the control group. Mean intervention costs was US$674 (95% confidence interval [CI]: 572–776) per subject in the intervention group. Average total direct costs were US$1445 (95% CI: 1086–1804) and US$1640 (95% CI: 1087–2093) per subject in the intervention and control groups respectively. From the societal perspective, intervention had more effects with lower costs. The ratios for incremental cost‐effectiveness was US$8399.1 (95% CI: 8178.2–8620.0) per quality‐adjusted life year (QALY) gained from the MoH perspective for 20 months of follow‐up. This study showed that aftercare services can create opportunities to use hospital beds more efficiently for unmet needs of people with psychiatric disorders. Indirect and intangible costs were not considered in this study, if taken into account, they are likely to further increase the efficiency of intervention.     

酸枣果肉多糖含量测定

目的:测定酸枣果肉当中多糖含量.方法:以苯酚-硫酸法,检测波长设置为490nm,采用紫外-可见分光光度仪测定.结果:酸枣果肉多糖线性范围在11.31μg/mL～56.55μg/mL(r=0.9987),平均加样回收率为99.01％,RSD为1.8％,8批样品平均多糖含量为5.7％.结论:本方法操作简单可行,分析方法验证各项指标均符合要求,可用于酸枣果肉多糖含量的检测.     

A clinical model to predict postoperative improvement in sub-domains of the modified Japanese Orthopedic Association score for degenerative cervical myelopathy

Purpose

The modified Japanese Orthopedic Association (mJOA) score consists of six sub-domains and is used to quantify the severity of cervical myelopathy. The current study aimed to assess for predictors of postoperative mJOA sub-domains scores following elective surgical management for patients with cervical myelopathy and develop the first clinical prediction model for 12-month mJOA sub-domain scores.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [Byron F.] Last name [Stephens], Author 2 Given name: [Lydia J.] Last name [McKeithan], Author 3 Given name: [W. Hunter] Last name [Waddell], Author 4 Given name: [Anthony M.] Last name [Steinle], Author 5 Given name: [Wilson E.] Last name [Vaughan], Author 6 Given name: [Jacquelyn S.] Last name [Pennings], Author 7 Given name: [Jacquelyn S.] Last name [Pennings], Author 8 Given name: [Scott L.] Last name [Zuckerman], Author 9 Given name: [Kristin R.] Last name [Archer], Author 10 Given name: [Amir M.] Last name [Abtahi] Also, kindly confirm the details in the metadata are correct.Last Author listed should be Kristin R. Archer

Methods

A multivariable proportional odds ordinal regression model was developed for patients with cervical myelopathy. The model included patient demographic, clinical, and surgery covariates along with baseline sub-domain scores. The model was internally validated using bootstrap resampling to estimate the likely performance on a new sample of patients.

Results

The model identified mJOA baseline sub-domains to be the strongest predictors of 12-month scores, with numbness in legs and ability to walk predicting five of the six mJOA items. Additional covariates predicting three or more items included age, preoperative anxiety/depression, gender, race, employment status, duration of symptoms, smoking status, and radiographic presence of listhesis. Surgical approach, presence of motor deficits, number of surgical levels involved, history of diabetes mellitus, workers’ compensation claim, and patient insurance had no impact on 12-month mJOA scores.

Conclusion

Our study developed and validated a clinical prediction model for improvement in mJOA scores at 12 months following surgery. The results highlight the importance of assessing preoperative numbness, walking ability, modifiable variables of anxiety/depression, and smoking status. This model has the potential to assist surgeons, patients, and families when considering surgery for cervical myelopathy.

Level of evidence

Level III.

     

Cytotoxic 3,4-secoapotirucallanes from Aaglaia argentea bark.

Nine 3,4-secoapotirucallanes, argentinic acids A-I, were isolated from the bark of Aglaia argentea and transformed to their methyl esters 1-9. The structures were determined by spectral and chemical means. Compounds 1-8 showed moderate cytotoxic activity against KB cells (IC50 1.0-3.5 microg/mL).     

川芎嗪油基纳米混悬剂在小鼠体内的组织分布研究

目的 研究川芎嗪纳米混悬剂在小鼠体内的组织分布.方法 采用高效液相色谱法测定小鼠血浆和组织中的川芎嗪浓度,计算药代动力学参数.结果 与川芎嗪片剂混悬液比,川芎嗪在小鼠脾肺脑组织中脑组织药时曲线下面积(AUC)和平均滞留时间(MRT)有显著性差异.结论 小鼠口服川芎嗪纳米混悬剂后在组织中有较高的药物含量,且维持时间较长,具有一定的脑靶向性.