Neurosyphilis presenting with psychotic symptoms and status epilepticus

The widespread use of antibiotics in recent years has considerably modified the clinical features of neurosyphilis. Presently, atypical or masked forms of this disease often occur and obscure diagnosis, despite a thorough history and clinical work-up. Here, we report a patient with neurosyphilis presenting with psychotic symptoms who then developed status epilepticus and left limb weakness. Diffusion-weighted magnetic resonance imaging showed hyperintensity involving the right parietal, occipital and temporal lobes and the thalamus. Subsequent serological and cerebrospinal fluid tests confirmed the diagnosis of neurosyphilis. The coexistence of meningovascular syphilis, syphilitic meningitis, and general paresis resulted in the complex manifestation of this patients’ condition, as described here in terms of the unusual presentation, evolution, and final diagnosis.     

Role of C3G/Rapl and Dock180/Rac1 signal pathway in infiltration of ovarian cancer

目的 探讨鸟嘌呤核苷酸交换因子C3G/Rap1酶和鸟嘌呤核苷酸交换因子Dock180/Rac1酶信号通路在卵巢癌浸润中的可能作用.方法 Western blot检测Dock180沉默的卵巢癌细胞SKOV3中C3G的表达,验证上皮性卵巢癌组织中Dock180与C3G的表达相关性；免疫组化比较卵巢癌组织中Dock180与C3G的表达趋势；免疫荧光观察SKOV3中Dock180与C3G及它们各自的下游蛋白Rac1/Rap1的定位.结果 Dock180基因沉默的细胞中C3G表达明显增强(P＜0.05)；Dock180与C3G在卵巢癌组织中的表达呈现相反趋势(P＜0.05)；C3G/Dock180均主要分布于细胞质,下游效应蛋白Rap1/Rac1在细胞膜和细胞质都有表达,但Rap1以细胞质为主,而Rac1可以伸展至细胞膜及细胞膜皱褶.结论 卵巢癌细胞和组织中C3G与Dock180表达呈相反趋势,下游蛋白Rap1与Rac1在细胞内的定位分布差异,可能与C3G/Rap1和Dock180/Rac1信号通路在卵巢肿瘤浸润中的不同作用有关.     

Capecitabine maintenance therapy in patients with recurrent or metastatic breast cancer

Our objective was to investigate the efficacy and safety of capecitabine maintenance therapy (CMT) after capecitabine-based combination chemotherapy in patients with metastatic breast cancer. The clinical data of 139 metastatic breast cancer patients treated from March 2008 to May 2012 with capecitabine-based combination chemotherapy were retrospectively analyzed. When initial disease control was achieved by the combination chemotherapy, we used CMT for 50 patients, while 37 patients were treated with a different (non-CMT) maintenance therapy. We compared time to progression (TTP), objective response rate, disease control rate, clinical benefit rate, and safety of the two groups, and a sub-group analysis was performed according to pathological characteristics. Sixty-four percent of the patients received a median of six cycles of a docetaxel+capecitabine combination chemotherapy regimen (range 1-45); the median TTP (MTTP) for the complete treatment was 9.43 months (95%CI=8.38-10.48 months) for the CMT group and 4.5 months (95%CI=4.22-4.78 months; P=0.004) for the non-CMT group. The MTTPs for the maintenance therapies administered after the initial capecitabine combined chemotherapy were 4.11 months (95%CI=3.34-4.87 months) for the CMT group and 2.0 months (95%CI=1.63-2.38 months) for the non-CMT group. Gastrointestinal side effects, decreased white blood cells and palmar-plantar erythrodysesthesia were the main adverse reactions experienced with the combination chemotherapies, CMT and non-CMT treatments. No significant differences in the incidence of adverse reactions were detected in the CMT and non-CMT patients. After initial disease control was achieved with the capecitabine-based combination chemotherapy, CMT can significantly prolong TTP rates with a favorable safety profile.     

慢性氟中毒大鼠骨组织Gli1、β-catenin表达变化及其与骨形成增强间的相关性分析

目的观察使用刺猬蛋白(Hedgehog)信号阻断剂环巴胺(cyclopamine,Cycl)对慢性氟中毒大鼠骨组织中神经胶质瘤相关癌基因同源蛋白1(glioma-associated oncogene homolog 1,Gli1)及β链蛋白(β-catenin)表达的影响,探讨两者表达变化在氟致骨形成增强中的意义。方法SD大鼠48只分为4组,每组12只。对照组饮用自来水(含氟量<1 ppm),氟中毒组(F组)、氟+环巴胺组(F+Cycl组)和氟+二甲基亚砜组(F+DMSO组)分别饮用含50 ppm氟化钠(NaF)的自来水。饲养6个月后分别给F+Cycl组和F+DMSO组大鼠腹腔注射环巴胺和DMSO。检测各组大鼠尿氟含量;酶联免疫吸附试验测定血清骨碱性磷酸酶(bone alkaline phosphatase,BALP)含量;HE染色观察骨组织形态计量学变化;实时荧光定量PCR法、免疫组织化学和蛋白印迹法检测骨组织中Gli1和β-catenin的mRNA和蛋白表达情况。结果染氟后F组、F+Cycl组和F+DMSO组大鼠尿氟含量、骨小梁密度、骨小梁宽度较对照组明显增加,但3组间未见明显差异(P>0.05)。F组较对照组血清BALP含量增加,Cycl阻断后血清BALP含量明显降低(P<0.05)。与对照组比较,F组Gli1和β-catenin mRNA和蛋白均有表达增强。使用Cycl后,两者表达均较F组降低(P<0.05),而F+DMSO组则无明显变化。Gli1与β-catenin的表达呈正相关关系(r=0.476,P<0.05);Gli1、β-catenin蛋白表达与血清BALP、骨小梁密度分别呈正相关关系(r1=0.457,r2=0.466,r3=0.581,r4=0.554,P<0.05)。结论Cycl可阻断慢性氟中毒大鼠骨组织Gli1表达,并且其影响成骨相关因子β-catenin的表达,这可能参与到氟致骨形成增强的过程中。     

磁锚定辅助牵引技术在食管早癌内镜黏膜下剥离术中应用的初步研究

目的目前,内镜黏膜下剥离术(ESD)已经成为消化道表浅癌的标准治疗方式,但对于食管病变,由于操作空间较为狭小,往往导致技术难度较大,手术耗时较长。本文报道了磁锚定牵引ESD治疗食管病变的初步结果。 方法2020年4月至2020年6月,共计5例食管浅表癌患者于解放军总医院第一医学中心接受磁锚定牵引ESD,前瞻性收集患者相关信息。 结果对于接受磁锚定牵引ESD的5例患者,整块切除率及完整切除率均为100%,R0切除率为80%,未见术中出血、术中穿孔、术后出血、术后穿孔等并发症发生。 结论初步研究结果证实,磁锚定牵引ESD治疗食管病变是安全可行的,但仍需进一步大样本的研究印证上述观点,并同时评估其长期有效性。     

十二指肠腺瘤的超声内镜图像特征

目的: 探讨十二指肠腺瘤的超声内镜(EUS)图像特征.材料和方法: 分析2001-01～2004-12 31例病灶≤2cm的十二指肠粘膜或粘膜下病变EUS表现(经内镜活检或电切病理确诊).结果: 31例共检出病灶34个,其中十二指肠腺瘤12个,炎性息肉8个,囊肿5个,脂肪瘤4个,胃粘膜异位4个,错构性息肉1个.十二指肠腺瘤病灶中10个呈等回声结节,2个呈强回声;11个病灶位于粘膜层,边界清晰,1例较大病灶与粘膜下层无分界.10个病灶内部回声不均匀,2个均匀较小病灶.结论: 十二指肠腺瘤的EUS主要表现为粘膜层内边界清晰的不均匀等回声结节,EUS检查能为十二指肠腺瘤正确诊断提供帮助.     

增强现实辅助电磁导航下的内镜逆行胰胆管造影胆管插管定位技术模型研究

背景 内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)术者时常会面临选择性肝内胆管超选困难的问题,且反复尝试插管大大增加了术后并发症的发生率.近年来,增强现实(augmented reality,AR)辅助电磁导航已成为微创手术的重要辅助工具.目的 探讨增强现实辅助电磁导航引导ERCP胆管插管在3D打印胆道模型中的定位精度.方法 将1例肝内外胆管扩张患者腹部CT图像中的胆道进行三维重建,将结果通过3D打印生成一个1:1.36的胆道树脂模型.在胆道模型内嵌入标记物作为导航精度测量的"靶点",并固定在人体腹部体模中.在体模基底和皮肤表面分别贴上配准标志物和标记物.对体模行CT平扫,得到体模的标准三维图形文件(STL).在乳头括约肌切开刀通道内部安装一个电磁传感器,用于追踪其在模型中的位置,并使用图像叠加构建一个增强现实导航平台.通过术前CT扫描获得体模配准标志物和标记物的图像坐标,实验中再获取其磁场坐标,完成术前、术中配准和增强现实精度分析.结果 在体模上行ERCP胆管插管,在AR辅助电磁导航下乳头括约肌切开刀被准确引导进入左右肝管,导航精度误差为(0.949±0.033)mm,可达到临床应用的要求.结论 模型实验证实了AR辅助电磁导航ERCP胆管插管的可行性,为其进一步在临床应用奠定了基础.     

3315例精神病人的社区防治护理

目的探讨精神病人社区防治护理方法,促使社区精神病人尽快康复,重返社会。方法采取防治结合,配合各种各样的社区康复护理。结果经过一年多的社区防治护理后,3315例患者中,好转2486例,显好率达75%。同时资助927位特困患者每月的药品费用,实施了23位患者的“解锁工程”。结论住院化管理不是精神病人康复的唯一方法,应积极推广“开放式、社会化、综合性”的社区防治护理。