神经外科中高渗盐注射液应用研究进展

控制脑水肿和颅内压(ICP)升高是神经外科围手术期治疗的重要组成部分.颅脑创伤、动脉梗塞、静脉高压/梗塞、大脑内出血、蛛网膜下腔出血、肿瘤和术后脑组织水肿的治疗过程中ICP的控制都是决定患者预后的关键因素.虽然利用渗透压脱水药物是控制ICP的最基础的工具,但却缺乏前瞻性研究以指导其运用,高渗盐被认为是甘露醇的替代物,早期的数据表明每种药的用药指征最终取决于ICP的病因.在这篇综述中,我们总结了有关高渗盐(HS)治疗颅内高压的相关数据,以及这些数据和我们有关HS的经验是如何指导目前的ICP治疗的.     

A Parathyroid Myxoadenoma Observed Grossly

We are reporting a case of a patient with primary hyperparathyroidism because of an unusual parathyroid adenoma. The tumor had an extensive myxofibrous stroma without an identifiable lipomatous component. Though moderate to extensive myxoid alteration of the stroma has been reported in lipoadenomas, to the best of our knowledge, this is the first parathyroid adenoma in which the myxomatous component was recognized grossly and which lacked a stromal adipose component.     

Clinicopathological analysis of ATRX,DAXX and NOTCH receptor expression in angiosarcomas

Aims

Multiple genetic alterations, including alternative lengthening of telomeres (ALT) and NOTCH mutations, have been described in angiosarcoma. Loss of α‐thalassaemia/mental retardation syndrome X‐linked (ATRX) and death domain‐associated protein 6 (DAXX) expression is frequently associated with the ALT phenotype. Additionally, inhibition of NOTCH signalling induces the development of malignant vascular tumours in mice, indicating a tumour suppressive role of the NOTCH pathway in the pathogenesis of angiosarcoma. The aim of this study was to evaluate the immunohistochemical expression of ATRX, DAXX and NOTCH receptors (NOTCH1 and NOTCH2) in a large cohort of angiosarcomas, and study their clinicopathological and prognostic significance.

Methods and results

One hundred and forty cases of angiosarcoma were stained for ATRX, DAXX, NOTCH1 and NOTCH2. ATRX loss (<10% labelling) was seen in seven of 118 (6%) cases, and was more frequent in deep soft tissue tumours than in other body sites (P = 0.004). Angiosarcomas with ATRX loss were associated with worse event‐free survival than angiosarcomas with retained ATRX expression (P = 0.003). DAXX was retained in all specimens examined. Decreased NOTCH1 expression (≤1+ intensity) was seen in 29 of 123 (24%) cases, and was associated with a cutaneous site of origin (P = 0.013) and advanced disease (P = 0.026). NOTCH2 expression was decreased in 16 of 103 (16%) cases, was associated with visceral tumours (P = 0.001), and correlated with worse disease‐specific survival (P = 0.033).

Conclusions

ATRX, NOTCH1 and NOTCH2 expression varies in angiosarcomas and shows significant correlations with site of origin and poor clinical outcome, thus highlighting the biological heterogeneity within this tumour type.     

Markedly Enhanced Cytochrome P450 2E1 Induction and Lipid Peroxidation Is Associated with Severe Liver Injury in Fish Oil—Ethanol-Fed Rats

We evaluated the role of changes in cytochrome P-450 2E1 (CYP 2E1) and lipid peroxidation in relation to development of severe liver injury in fish oil–ethanol-fed rats. The experimental animals (male Wistar rats) were divided into 5 rats/group and were fed the following diets for 1 month: corn oil and ethanol (CO+E) or corn oil and dextrose (CO+D), and fish oil and ethanol (FO+E) or fish oil and dextrose (FO+D). For each animal, microsomal analysis of CYP 2E1 protein, aniline hydroxylase activity, fatty acid composition, and conjugated dienes was conducted. Also, evaluation of severity of pathology was done for each rat. The mean ± SD of the pathology score was significantly higher ( p < 0.01) in the FO+E (6.0 ± 1.3) group than in the CO+E group (3.0 ± 0.5). No pathological changes were evident in the dextrose-fed controls. The CYP 2E1 protein levels (mean ± SD) were significantly higher ( p < 0.01) in the FO+E group (13.1 ± 2.0) compared with the CO+E (4.7 ± 1.2) and FO+D (1.8 ± 0.5) groups. Higher levels of eicosapentaenoic and docosa-hexaenoic acids and lower levels of arachidonic acid were detected in liver microsomes from rats fed fish oil compared with corn oil. A significant correlation was obtained between CYP 2E1 protein and conjugated diene levels ( r = 0.78, p < 0.01). Our results showing markedly increased CYP 2E1 induction and lipid peroxidation in the FO+E group provides one possible explanation for the greater severity of liver injury in this group.     

Depression and depressive symptoms in rheumatoid arthritis patients: an analysis of their occurrence and determinants

The objectives were to determine the differences in depressive symptoms and depression between rheumatoid arthritis (RA) and osteoarthritis (OA) patients, and to analyse the contribution of sociodemographic and clinical variables to depression in RA patients. The responses of 60 Egyptian RA patients and 40 patients with OA of the knees to the Symptom Checklist-90-R Depression subscale were compared. The proportions of patients from both groups confirmed by a psychiatric interview to be clinically depressed according to the DSM-III-R criteria were also compared. The contributions of sociodemographic and disease variables to depressive symptoms and clinical depression in RA patients were explored by multiple linear and logistic regression, respectively. RA patients showed significantly higher depression scores than OA patients (P = 0.001). The difference was unaffected by controlling for the effects of age, sex, disease duration and the sociodemographic covariates. A depressive disorder was clinically confirmed in 23% of RA patients and 10% of OA patients. The erythrocyte sedimentation rate (ESR), being unmarried and an urban residence were significant predictors of depressive symptoms (P < 0.05), while being unmarried (P < 0.05, OR = 2.1) and HAQ disability (P < 0.01, OR = 3.8) were significant predictors of clinical depression in RA patients. RA patients have significantly more depressive symptoms and tend to be more clinically depressed than OA patients. The contribution of some sociodemographic and clinical variables to depression in RA patients was modest, albeit significant.      

Owning the tooth: exploring the ethical and legal issues relating to the use of extracted human teeth in dental education in Australia

Extracted human teeth have been used to practice operative techniques for a very long time. As a natural surrogate for a live tooth in vivo, their use has traditionally been very important for the development of skills in trainee dentists, as well as their qualified colleagues who wish to practise existing or new skills. As synthetic alternatives develop greater authenticity, alongside a society in which many retain their natural dentition well into old age, the current paradigm relating to how extracted teeth in dental education are used needs to be revisited. An ethical and legal dilemma that must be addressed within dental education relates to where and how teeth may be sourced. This article will seek to question whether there is a legal or ethical requirement to gain consent for the use of extracted teeth from patients, as well as exploring the status of whether extracted dental tissue can be considered to be the property of either patient or surgeon. Whilst synthetic alternatives are being utilized more frequently in education, it is unlikely that they will completely replace extracted natural teeth in the immediate future. It is therefore imperative that their use complies with legal doctrine and contemporary ethical thought.     

急性脑出血患者卒中相关性肺炎发病的危险因素分析

目的探讨急性脑出血患者卒中相关性肺炎(SAP)发生的危险因素,以便早期干预。方法选择急性脑出血患者196例为研究对象,其中发生SAP 82例为病例组,未发生SAP 114例为对照组。对两组的年龄、性别、心肺疾病史、GCS评分、吞咽困难、心率、血压、白细胞计数、脑出血量、鼻饲、使用胃黏膜保护剂和手术等共计23项予以比较分析。所得资料在单因素分析的基础上,又作多因素Logistic回归分析。结果急性脑出血SAP的患病率为41.837%。收缩压升高(优势比1.072,95%可信区间1.007~1.141,P=0.029)、白细胞计数增加(优势比1.331,95%可信区间1.009~1.756,P=0.043)、脑出血量增多(优势比1.079,95%可信区间1.019~1.142,P=0.010)、有心肺疾病(优势比12.275,95%可信区间1.210~124.545,P=0.034)、吞咽困难(优势比12.937,95%可信区间1.918~87.250,P=0.009)和鼻饲(优势比19.217,95%可信区间1.307~282.651,P=0.031)均促进发病。而使用胃黏膜保护剂(优势比0.157,95%可信区间0.031~0.790,P=0.025)和实施手术(优势比0.012,95%可信区间0.000~0.294,P=0.007)阻止发病。结论收缩压、白细胞计数增加、脑出血量增高、有心肺疾病、吞咽困难和鼻饲是急性脑出血发生SAP的危险因素;而使用胃黏膜保护剂和实施手术为其保护因素。