中枢神经系统血管内大B细胞淋巴瘤:病例报告并文献复习

目的 更好地了解血管内大B细胞淋巴瘤(IVLBCL)的临床特点、病理和免疫组化特征.方法 总结我科一例确诊病例,并结合文献进行分析.对患者的临床表现及影像特点进行观察,对手术病理标本进行组织学和免疫组化观察.结果 原发性中枢神经系统血管内大B细胞淋巴瘤罕见,临床表现多样化,本例患者主要表现为肌力轻度减退、认知功能进行性下降、意识障碍、继发性癫等,头颅MRI显示白质深部的多发病灶,呈T1WI低信号、T2WI和FLAIR高信号,增强扫描后病灶呈不规则斑片状、小环状强化灶.临床病情迅速恶化.其病理学特征是肿瘤细胞积聚于小血管内、血管周围间隙和毛细血管内,免疫标记脑组织毛细血管内异型细胞,LCA、CD20、CD79a表达阳性,个别细胞呈ki67阳性.CD3、UCHL-1、CD30、KP-1表达呈阴性,确诊IVLBCL.结论 IVLBCL是高度侵袭性疾病,进展快、预后差.早期诊断和联合化疗可能有益.     

格列齐特缓释片对2型糖尿病患者血管功能的影响

目的观察格列齐特缓释片对2型糖尿病(T2DM)患者血管功能的影响。方法72例T2DM患者随机均分为对照组(口服格列齐特片,80 mg／次,每日2次)和试验组(口服格列齐特缓释片,60 mg／次,每日1次),疗程为12周。采用高分辨率超声测定肱动脉内皮依赖性血管舒张功能(FMD)和硝酸甘油介导的非内皮依赖性血管舒张功能(GNTMD)的变化,并测定血清一氧化氮(NO)及内皮素-1(ET-1)的水平。同时选择40名年龄和性别相匹配的健康志愿者(正常组)作为基线对照。结果与正常组比较,治疗前试验组和对照组的血清ET-1水平显著升高(P值均<0.01),血清NO水平及GNTMD、FMD值显著下降(P值均<0．01)。与治疗前比较,治疗12周后试验组和对照组血清ET-1水平显著降低(P值均<0．01),NO水平和GNTMD、FMD值显著上升(P值均<0．01)。试验组和对照组均能有效降低空腹和餐后2 h血糖及糖化血红蛋白水平,差异均有统计学意义(P值分别<0．05、0．01)。结论格列齐特缓释片和普通片可在有效降低T2DM患者血糖的同时,改善血管内皮功能。     

印度新专利法的实行对医药企业的影响

印度和我国一样都是发展中国家,人口众多,在医药领域既有很多相似之处,又存在激烈竞争:首先,从地理、人口、经济发展等方面看,中印两国国情比较相近,两国的制药产业也有惊人的相似之处(成本低廉,药品可获得性高);大部分企业仍处于低水平重复仿制阶段;研发力量较为薄弱,仿制药比     

葛根素对慢性偏头痛小鼠三叉神经节细胞钠离子电流及动作电位的影响

目的 通过观察葛根素对硝酸甘油诱导的慢性偏头痛模型小鼠行为学、三叉神经节细胞钠离子电流抑制率和动作电位的影响,探讨其治疗慢性偏头痛的作用机制。方法 随机取6只雄性C57BL/6小鼠,处死后分离三叉神经节细胞,检测不同浓度的葛根素对电压依赖性钠离子通道电流的抑制率。建立硝酸甘油诱导的慢性偏头痛小鼠模型,给予药物干预后,qRT-PCR检测三叉神经节细胞神经元电压门控钠通道基因（voltage-gated sodium channel α1-subunit gene,SCN1A）mRNA表达;用膜片钳记录各组小鼠三叉神经节细胞的动作电位参数。结果 葛根素对正常小鼠三叉神经节细胞的电压门控性钠离子通道抑制率的半数抑制浓度（half inhibitory concentration,IC₅₀）为29.96 μmol/L。与对照组比较,模型组小鼠0～30、30～60、60～90、90～120 min各时间段抓头次数及2 h内抓头次数总和显著增加（P＜0.05、0.001）,三叉神经节细胞中SCN1A mRNA表达显著升高（P＜0.001）,动作电位发放频率和静息膜电位显著升高（P＜0.001）。与模型组比较,葛根素（50、100、200 mg/kg）组30～60 min抓头次数和2 h内抓头次数总和显著减少（P＜0.05、0.01）,葛根素（200 mg/kg）组90～120 min抓头次数显著减少（P＜0.001）;葛根素（100、200 mg/kg）组小鼠三叉神经节细胞中SCN1A mRNA表达显著降低（P＜0.001）;葛根素（50、100、200 mg/kg）组小鼠三叉神经节细胞动作电位发放频率和静息膜电位显著下降（P＜0.001）。结论 葛根素通过阻断三叉神经节细胞钠离子电流和SCN1A mRNA表达,降低动作电位静息膜电位和发放频率,减少慢性偏头痛发作,有望成为临床治疗慢性偏头痛的辅助治疗药物。     

桃仁现代研究进展和炮制方法历史沿革

桃仁Persicae Semen具有活血祛瘀、润肠通便、止咳平喘的功效,在我国具有广泛且悠久的应用历史。通过查阅历代本草典籍及现代研究文献报道,梳理桃仁的历史沿革,并对其现代炮制规范的研究进展进行归纳。为了全面理解药材,对桃仁的化学成分和药理作用的研究进展进行综述,还特别关注了药对配伍使用角度。有助于从多个方面全面了解药材的特性和潜在效果,为后续对桃仁炮制前后主要成分、指纹图谱、药理活性变化和减毒增效机制的研究提供研究思路,以期为其质量评价、临床应用和资源开发提供科学的理论依据。     

侯氏黑散治疗缺血性中风的理论探析

侯氏黑散出自《金匮要略》,具有祛风化痰、补虚除热、祛瘀通络之功.然而历代医家对其认识不一,通过对此方进行方义阐释,分析侯氏黑散与缺血性中风的关系,结合临床验案,笔者认为此方属于仲景博采众方所录,病机为心脾气血亏虚,风痰阻络,为内外风同治之方,临床用于缺血性中风的预防与治疗,疗效显著.     

IL-1 receptor-associated kinase 1 participates in the modulation of the NLRP3 inflammasome by tumor-associated macrophages in hepatocellular carcinoma

BackgroundHepatocellular carcinomas (HCCs) occur frequently in the digestive system and are associated with high mortality. This current study examined the regulatory relationship between interleukin (IL)-1 receptor-associated kinase 1 (IRAK1), NLR family pyrin domain-containing 3 (NLRP3) inflammasomes, and tumor-associated macrophages (TAMs) in the growth and metastasis of HCC.MethodsThe expression of IRAK1 and NLRP3 was assessed in tissues and cells via quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot analysis. Immunohistology was performed to detect the macrophage markers CD68, CD163, and CD168 in tumor tissues. Small interfering (si)RNA targeting IRAK1 (si-IRAK1) was designed to silence IRAK1 expression. Following si-IRAK1 transfection and/or co-culture with TAMs, HCC cell viability, proliferation, migration, and invasion, as well as the expression of NLRP3 and pro-inflammatory cytokines IL-1 β, IL-18, and monocyte chemotactic protein 1 (MCP-1) were assessed.ResultsHCC tissues showed elevated expression of IRAK1 and NLRP3, as well as increased expression of the macrophage markers CD68, CD163, and CD168, compared to adjacent healthy tissues. Silencing of IRAK1 expression in HepG2 and Huh7 cells resulted in suppression of cell proliferation, migration, and invasion, and also reduced expression of NLRP3 and the pro-inflammatory cytokines IL-1β, IL-18, and MCP-1. Moreover, TAMs promoted HepG2 and Huh7 cell proliferation, migration, and invasion, and elevated the expression of NLRP3, IL-1β, IL-18, and MCP-1. Furthermore, IRAK1 silencing reversed the effects of TAMs on HepG2 and Huh7 cells.ConclusionsThe expression of IRAK1 was associated with HCC growth and metastasis, as well as NLRP3 inflammasome activation. The ability of TAMs to promote HCC growth and metastasis may be activated by NLRP3 inflammasomes and regulated by IRAK1.     

Intraoperative malignant glaucoma during femtosecond laser-assisted cataract surgery: A case report

Rationale:Femtosecond laser-assisted cataract surgery (FLACS) has grown in popularity among ophthalmologists as a novel surgical technique. However, malignant glaucoma (MG) is a complication of FLACS. Herein, we report a case of MG following FLACS.Patient concerns:A 66-year-old woman presented with complaints of blurred vision in the right eye and a foreign body sensation in both eyes. Ophthalmological examinations showed that the corrected distance visual acuity was 20/50 and 20/25 in the right and left eyes, respectively. Without any topical anti-glaucoma medication, the intraocular pressure (IOP) was 20 mmHg in the right eye and 17 mmHg in the left eye. Slit-lamp examination of the right eye revealed a transparent cornea with a defect in the punctate overlying epithelium; the central anterior chamber depth was shallow the peripheral iris laser shot was visible, the pupil was normal, and the lens was mainly cortical opacified.Diagnoses:Based on the patient''s symptoms, examination results, and preliminary diagnoses, age-related cataract in the right eye, binocular post-antiglaucoma surgery, pseudophakicin in the left eye, and Sjogren syndrome were included.Interventions:FLACS was performed to facilitate anterior capsulotomy and segmentation of the nucleus in the right eye. MG occurred after the femtosecond procedure, and with the treatment of medicines combined with phacoemulsification, IOP was eventually normal without further antiglaucoma therapy.Outcomes:IOP was 16 mmHg on postoperative day 1. Ocular ultrasonography revealed no choroid detachment or hemorrhage in the right eye. Two weeks postoperatively, uncorrected visual acuity was 20/25, and IOP remained normal with no further antiglaucoma treatment on 1 month postoperatively.Conclusions:We describe the occurrence of MG after FLACS and illustrate that miosis and bubble formation after FLACS may be risk factors for MG during FLACS.     

Displaced proximal humerus fractures treated with ORIF via the deltoid interfascicular approach vs the deltopectoral approach: A prospective case-control study

Background:The purpose of this study was to evaluate the clinical outcomes and complications of displaced proximal humeral fractures treated with proximal humeral internal locking system (PHILOS) plate fixation via a deltoid interfascicular (DI) vs a deltopectoral (DP) approach.Methods:This prospective case-control study was conducted with patients admitted to our hospital from May 2015 to June 2018 who suffered from unilateral displaced proximal humerus fractures. Patients were treated with PHILOS plate fixation via a DI (DI group) or DP approach (DP group). The clinical outcomes and complication data were collected for comparison between the 2 groups. The patients were followed up at 3, 6, and 12 months; and every 6 months thereafter. The patients’ functional recoveries were evaluated according to the normalized Constant-Murley score, range of motion of the shoulder (flexion, abduction, external/internal rotation) and disabilities of the arm, shoulder and hand score.Results:A total of 77 patients, followed for an average of 15 ± 2.2months (range, 12–21), were enrolled (36 in DI group and 41 in DP group) for final analysis. No significant differences in age, sex, affected side, fracture type, injury mechanism or time from injury to operation were found between the 2 groups (all P > .05). The incision length, intra-operative blood loss, and duration of operation in the DI group were significantly less than those in the DP group, respectively (all P < .05). The functional outcomes assessed by the normalized Constant-Murley score and range of motion of flexion and internal rotation in the DI group were superior to those in the DP group at 3 and 6months after the operation (P < .05); however, no significant differences were observed at the 12-month and subsequent follow-ups (all P > .05). There was no significant difference in the range of shoulder external rotation and abduction during the postoperative follow-ups (P > .05). At the last follow-up, the mean disabilities of the arm, shoulder, and hand score was 14.0 (6.6) points in the DI group and 14.4 (6.9) points in the DP group (P = .793). Complications occurred in 1 patient in the DI group and 8 patients in the DP group (P = .049).Conclusion:The current study demonstrates that DI approach is a safe and effective alternative for the treatment displaced proximal humerus fractures. The DI approach rather than DP approach was recommended when lateral and posterior exposure of the proximal humerus is required, especially when fixed with PHILOS plate.