Higher Glucocorticoid Secretion in the Physiological Range Is Associated With Lower Bone Strength at the Proximal Radius in Healthy Children: Importance of Protein Intake Adjustment

Whether higher production of glucocorticoids (GCs) within the physiological range may already be affecting bone status in healthy children is unknown. Because dietary protein intake affects both bone and GCs, we examined the association of urinary measures of glucocorticoid status and cortical bone in healthy non‐obese children, after particularly controlling for protein intake. Proximal forearm bone parameters were measured by peripheral quantitative computed tomography (pQCT). Subjects studied (n = 175, 87 males, aged 6 to 18 years) had two 24‐hour urine samples collected: the first sample at 1 year before bone measurement, and the second sample at the time of bone measurement. Major urinary GC metabolites were measured by mass spectrometry and summed to assess daily adrenal GC secretion (∑C21). Urinary free cortisol (UFF) and cortisone (UFE) were summed to assess potentially bioactive free GCs (UFF + UFE). After controlling for several covariates and especially urinary nitrogen (the biomarker of protein intake) cortisol secretion ∑C21 was inversely associated with all analyzed pQCT measures of bone quality. ∑C21 also predicted a higher endosteal and lower periosteal circumference, explaining both a smaller cortical area and (together with lower BMD) a lower strength‐strain‐index (SSI). UFF + UFE, UFE itself, and a urinary metabolite‐estimate of 11beta‐hydroxysteroid dehydrogenase type1 (11beta‐HSD1) activity showed corresponding reciprocal associations (p < 0.05) with BMD and bone mineral content, but not with SSI and bone geometry variables. In conclusion, higher GC levels, even within the physiological range, appear to exert negative influences on bone modeling and remodeling already during growth. Our physiological data also suggest a relevant role of cortisone as the direct source for intracrine‐generated cortisol by bone cell 11beta‐HSD1. © 2014 American Society for Bone and Mineral Research.     

Brain structure links trait creativity to openness to experience

Creativity is crucial to the progression of human civilization and has led to important scientific discoveries. Especially, individuals are more likely to have scientific discoveries if they possess certain personality traits of creativity (trait creativity), including imagination, curiosity, challenge and risk-taking. This study used voxel-based morphometry to identify the brain regions underlying individual differences in trait creativity, as measured by the Williams creativity aptitude test, in a large sample (n = 246). We found that creative individuals had higher gray matter volume in the right posterior middle temporal gyrus (pMTG), which might be related to semantic processing during novelty seeking (e.g. novel association, conceptual integration and metaphor understanding). More importantly, although basic personality factors such as openness to experience, extroversion, conscientiousness and agreeableness (as measured by the NEO Personality Inventory) all contributed to trait creativity, only openness to experience mediated the association between the right pMTG volume and trait creativity. Taken together, our results suggest that the basic personality trait of openness might play an important role in shaping an individual’s trait creativity.     

急诊科护士遭受躯体暴力的预测线索探讨

目的探讨急诊科护士发生躯体暴力的预测线索。方法对四川省和重庆市5所医院的急诊科进行观察性研究,由专人观察和记录患方的行为线索,并根据行为变化是否转化为躯体暴力分为躯体暴力组和非躯体暴力组,统计分析两组行为变化的例数和躯体暴力的行为方式,采用Logistic回归分析确定护士发生躯体暴力的特定预测线索。结果共观察287例患者,非躯体暴力组219例,转化为躯体暴力组68例,躯体暴力发生率23.7%。Logistic回归分析显示当患方出现紧握双拳(OR=6.334)、挑衅(OR=5.672)、抵制护理措施(OR=5.164)、大声争吵(OR=4.651)、紧跟护理人员(OR=3.334)或鲁莽(OR=3.172)是发生躯体暴力的最强预测线索(P0.05,P0.01)。结论急诊科发生躯体暴力比较普遍,应快速、方便、有效地评估患方潜在的躯体暴力风险,采取相应的防范措施,以减少躯体暴力风险的发生,避免急诊科护士受到身体和心理伤害。     

A novel method for lymphadenectomy along the left laryngeal recurrent nerve during thoracoscopic esophagectomy for esophageal carcinoma

Background

Due to limited space in the left upper mediastinum, complete dissection of lymph nodes (LN) along left recurrent laryngeal nerve (RLN) is difficult. We herein present a novel method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the semi-prone position for esophageal carcinoma. The method, suspension the esophagus and push aside trachea, allows en bloc lymphadenectomy along the left RLN from the below aortic arch to the thoracic inlet.

Methods

Between September 2014 and September 2015, a total of 110 consecutive patients with esophageal carcinoma were treated with thoraco-laparoscopic esophagectomy with cervical anastomosis in the semi-prone position. Outcomes between those who received surgery with the novel method and conventional surgery were compared.

Results

Fifty patients underwent the novel method and sixty received conventional surgery. The operative field around the left RLN was easier to explore with the novel method. The estimated blood loss was less (23.7±8.2 vs. 34.2±10.3 g, P=0.001), and the number of harvested LNs along the left RLN was greater (6.4±3.2 vs. 4.1±2.8 min, P=0.028) in the novel method group, while the duration of lymphadenectomy along left RLN was longer in the novel method group (28.2±3.9 vs. 20.3±2.8 min, P=0.005). The rate of hoarseness in the novel and conventional groups was 10% and 16.7%, respectively. No significant difference in postoperative morbidity related to the left RLN was noted between the groups.

Conclusions

The novel method during semi-prone esophagectomy for esophageal carcinoma is associated with better surgeon ergonomics and operative exposure.     

微创经皮肾镜取石术中X线或B超引导穿刺目标肾盏治疗上尿路结石的疗效比较

目的 比较微创经皮肾镜取石术中,用X线或B超引导穿刺目标肾盏治疗上尿路结石的临床疗效.方法 回顾性分析2010年10月-2012年10月,昆明医科大学第二附属医院泌尿外科住院行微创经皮肾镜取石术的患者,抽取116例作为研究对象,失访8例.X线定位48例,B超定位53例,就两种不同定位方式的术前、术中、术后的一些临床客观指标进行比较.结果 X线定位48例,年龄6 ～65(44.86±12.84)岁;结石直径(1.43±0.70) cm;结石位于上盏1例、中盏23例、下盏8例、输尿管上段16例.B超定位53例,年龄15 ～76(46.36±14.29)岁;结石直径(1.34±0.62)cm;结石位于上盏2例、中盏24例、下盏8例、输尿管上段16例,充满全部肾盏3例.比较两组术前一般资料,差异无统计学意义(P＞0.05).X线组,手术时间(130.43±31.63) min;术中出血量(80.42±43.75) mL;术后住院时间(6.20±2.08)d;术后并发感染8例(17％),出血2例(4％);一期结石取尽率90％ (43/47).B超组,手术时间(102.45±36.32) min;术中出血量(160.07 ±52.33) mL;术后住院时间(5.62±2.37)d;术后并发感染16例(30％),出血9例(17％);一期结石取尽率83％(46/53).通过比较,X线组与B超组在手术时间、术中出血量、术后感染率、一期结石取尽率有统计学意义(P＜0.05),而术后住院时间无统计学意义(P＞0.05).结论 微创经皮肾镜取石术中,X线定位与B超比较,X线比B超手术时间长,术中出血量少,一期结石取尽率高,术后感染率低.     

带绦虫精母细胞发生的超微结构观察

目的：在超微结构水平研究带绦虫精母细胞的发生。方法：透射电镜。结果：本文对猪带绦虫，牛带绦虫，及豆状带绦虫的精母细胞的发生进行了ＴＥＭ观察，结果精母细胞的发生（ｓｐｅｒｍａｔｏｃｙｔｏｇｅｎｅｓｉｓ）可分辨出两种精原细胞：Ａ型和Ｂ型，以及包绕其周围的支持细胞。Ａ型精原细胞为干细胞。Ｂ型为母细胞。Ｂ型精原细胞经４次无细胞分离的有丝分裂，形成１６个初级精母细胞，其特点为胞质中存在核糖体团。初级精母细胞经减数分裂产生３２个次级精母细胞，排列成玫瑰花团样。次级精母细胞经短暂的发育过程很快形成精细胞。结论：带绦虫精原细胞的分裂方式为无细胞分离的有丝分裂。     

Shikonin protects chondrocytes from interleukin-1beta-induced apoptosis by regulating PI3K/Akt signaling pathway

Chondrocyte apoptosis is mostly responsible for the development and progression of osteoarthritis. IL-1β is generally served as an agent that induces chondrocyte apoptosis. Shikonin exerts its anti-inflammatory effect on cartilage protection in vivo. We aimed to explore the protective effect of shikonin on interleukin-1beta (IL-1β)-induced chondrocyte apoptosis and the potential molecular mechanisms. Chondrocytes were isolated from the joints of newborn Sprague-Dawley rats. The MTT assay and LDH cell death assay were used to determine the cell viability and chondrocyte apoptosis was detected by Annexin-V/PI staining and nucleosomal degradation. The contents of phosphorylated-PI3K (p-PI3k), phosphorylated-Akt (p-Akt), Bcl-2, Bax, and cytochrome c were detected by Western blotting. A quantitative colorimetric assay was used to detect the caspase-3 activity. Our results showed that pretreatment with shikonin (4 μM) inhibited cytotoxicity and apoptosis induced by IL-1β (10 ng/ml) in chondrocytes. Shikonin pretreatment also decreased the activity of IL-1β that decreased Bcl-2 expression and levels of p-PI3K and p-Akt, and increased Bax expression, cytochrome c release, and caspase-3 activation. It also reversed the activity of IL-1β that promoted the synthesis of matrix metalloproteinase-13 and inhibited the expression of tissue inhibitor of metalloproteinase-1 expression, with the net effect of suppressing extracellular matrix degradation. These data suggested that shikonin may protect chondrocytes from apoptosis induced by IL-1β through the PI3K/Akt signaling pathway, by deactivating caspase-3.     

错误相关负电位在精神科临床上推广——附50例正常成人分析

目的:应用引进的德国仪器及新技术探讨并建立健康成人错误相关负电位(ERN)的正常值。方法:应用德国Brain Products公司的ERP记录与分析系统,对50例21~55岁健康成人右利手受试者,作了ERN检测。结果:(1)32个头皮记录点皆在约100~150ms处出现了一个负波,健康成人ERN波形较稳定。(2)在Cz、Fz、Pz、C3、C4 5个脑区,建立了健康成人ERN潜伏期和波幅均值。(3)左右侧比较及男女性别比较差异无统计学意义(P>0.05)。结论:健康成人ERN较稳定和可靠。ERN可作为一个有临床推广应用价值的ERP而用于神经精神科临床。     

Transcervical minimally invasive esophagectomy: hemodynamic study on an animal model

BackgroundTranscervical esophagectomy is a less invasive procedure performed within mediastinum. However, the mediastinum offers limited surgical space and the surgery via this route differs from conventional minimally invasive esophagectomy. Therefore, the physiological study of this surgical approach on an animal model would be necessary before the procedure gained more popularity.MethodsWe conducted transcervical minimally invasive esophagectomy on animal model (swine) under CO₂ pneumomediastinum. The hemodynamic parameters were monitored using float catheter cannulated via right jugular vein. At different anatomical level (the upper, middle, and lower thoracic part of the animal esophagus), increased artificial pneumomediastinal pressures (0, 4, 8, 12, and 16 mmHg) were consecutively allocated to record the intra-operative changes of blood pressure, cardiac output (CO), central venous pressure (CVP), pulmonary artery pressure (PAP) and extravascular lung water (EVLW). Meanwhile, the surgical field under different pneumomediastinum pressure was recorded and balanced with animals’ hemodynamic changes to determine the optimal pressure for transcervical minimally invasive esophagectomy.ResultsThe animal procedures were accomplished without conversions. During the upper thoracic stage, increased CO₂ pressures did not lead to significant changes in hemodynamic parameters including the blood pressure, CO, CVP, PAP or the level of EVLW. During the middle thoracic stage, pneumomediastinum under 4–12 mmHg did not lead to significant changes in hemodynamic parameters. However, pneumomediastinum at 16 mmHg resulted in lower CO (P=0.038) when compared to 0–12 mmHg. During lower thoracic stage, as the pneumomediastinum pressures increased from 0 to 16 mmHg, significant decrease in CO (P=0.022), and increase in CVP (P=0.036) was recorded. In compared to 4 mmHg pneumomediastinum, the surgical field under 8–16 mmHg artificial CO₂ pneumomediastinum was suitable for mediastinal manipulation.ConclusionsDuring transcervical minimally invasive esophagectomy on animal model, the mobilization of swine thoracic esophagus with optimal pneumomediastinum pressure 8–12 mmHg is safe and effective based on hemodynamic analysis.