食管囊肿2例

食管囊肿为罕见良性肿瘤, 我院经手术、病理证实2 例,现报道如下。     

儿童感音神经性耳聋中先天性内耳畸形的临床特征

目的：分析在儿童感音神经性耳聋（sensorineural hearing loss,SNHL）中先天性内耳畸形患儿的影像学及临床特征。方法：回顾分析860例SNHL患儿中因听力障碍（109例）、外耳畸形（3例）、面部异常（13例）来就诊的125例（225耳）患儿的临床资料。结果：109例（87.2%）患儿因听力障碍就诊,母亲妊娠早期有感冒史52例（41.6%）。166耳（73.8%）极重度耳聋,累及双侧100例（80%）。颞骨高分辨率CT或磁共振成像（MRI）显示其中同时合并外耳及中耳畸形3耳,合并中耳畸形13耳。Michel畸形2例（4耳）,耳蜗不发育1例（1耳）,共同腔畸形10例（14耳）,不完全分隔-I型2例（2耳）,耳蜗前庭发育不良2例（2耳）,不完全分隔-II型（Mondini畸形）19例（29耳）。累及前庭导水管扩大91例（170耳）（75.6%）,半规管畸形30例（46耳）（20.6%）,内听道畸形35例（49耳）（21.7%）。结论：前庭导水管扩大是儿童SNHL中最常见的内耳影像学异常。患儿多为双侧重度听力损失或全聋。对于先天性内耳畸形的患儿行高分辨率CT检查非常重要。     

Implications of dietary α-linolenic acid in bone health

Recent evidence implies the benefit of ω-3 polyunsaturated fatty acids in bone health. Although eicosapentaenoic acid and docosahexaenoic acid, present in fish oil, have been extensively researched, much less is known about the influence of α-linolenic acid (ALA; present in flaxseeds), a metabolic precursor of eicosapentaenoic acid and docosahexaenoic acid, on bone. Our objective was to evaluate the published literature and distinguish between the individual effects of flaxseed oil and flax lignans on bone to elucidate the exact role of ALA in skeletal biology. The search was conducted in several databases resulting in 129 articles of which 30 were eligible for inclusion in this review. The studies showed that consumption of whole flaxseeds did not lead to a marked improvement of osteoporotic bones in humans and animals. However, when combined with estrogen therapy, flaxseed supplementation offered an extra benefit to bone in animal models. Similar results were found in studies conducted with flaxseed oil (predominantly ALA), but the favorable role of flaxseed oil was more obvious in various pathologic conditions (kidney disease, obesity with insulin resistance), resulting in improved bone properties. In contrast, despite a marginal estrogenic effect, the consumption of flax lignans resulted in little benefit to bone and the effect was limited to early life of females only in animal models. Based on the available studies, it could be concluded that supplementation with flaxseeds may contribute to some improvement in osteoporotic bone properties but the bone-protective effect may be attributed to ALA, not to the lignan fraction of flaxseeds.     

Astragaloside Ⅳ exerts drug interactions via inhibiting CYP1A2 activity in rats

目的 研究黄芪甲苷对大鼠体内CYP1A2酶活性的影响,阐明由CYP1 A2酶所引发的药物相互作用可能性.方法 采用色谱柱为waters-symmetry C18柱(250 mm ×4.6 mm 1.D.,5μm);流动相为甲醇和水(体积比17∶83);检测波长=274 nm;柱温=30℃;流速=1 ml/min的色谱条件.7只SD大鼠随机分为2组,实验组3只预给予黄芪甲苷1周,对照组4只给予0.1％ DMSO水溶液,第8天分别给予茶碱,通过高效液相色谱法测定探针药物荣碱的血药浓度,比较2组的动力学参数的差异来考察黄芪甲苷对CYP1A2酶活性的影响.结果 茶碱、内标对乙酰氨基酚二者分离良好且无内源性干扰,茶碱的最低检测限80 nmol/L,线性范围0.2～50 μmol/L,日内日间精密度均小于10％,提取回收率大于91％,实验组的动力学参数药物浓度-时间曲线下面积AUC(0-∞)(131.16±3.22)明显高于对照组(97.51±6.40),而体内总体清除常数CL/F(0.12±0.01)明显低于对照组(0.17±0.02) (P＜0.05).结论 黄芪甲苷对大鼠体内CYP1 A2酶活性有明显的抑制作用,临床用药中应尽量避免与由CYP1 A2所代谢的药物联合应用.     

Hematologic toxicities in cancer patients treated with the multi-tyrosine kinase sorafenib: a meta-analysis of clinical trials

Background

Sorafenib is a vascular endothelial growth factor receptor tyrosine-kinase inhibitor currently used in several malignancies. While not a traditional cytotoxic chemotherapeutic agent, hematological toxicities have been reported with this drug but the incidence and risk have not been formerly assessed. We performed a meta-analysis to determine the incidence and risk of hematologic toxicities associated with sorafenib use.

Methods

The databases of Medline were searched for articles from 1966 to May 2010. Abstracts presented at the American Society of Clinical Oncology meetings were also searched. Eligible studies include randomized trials with sorafenib, and adequate safety data profile reporting anemia, neutropenia, lymphopenia or thrombocytopenia. Statistical analyses were conducted to calculate the summary incidence, RR and 95% confidence intervals (CI).

Results

A total of 3221 patients were included. The incidences of sorafenib-associated all-grade anemia, neutropenia, thrombocytopenia and lymphopenia were 43.9%, 18.0%, 25.3% and 34.1%, respectively. The incidences of high-grade events were 2.0%, 5.1%, 4.0% and 13.1%, respectively. Sorafenib was associated with a decreased risk of high-grade anemia (RR = 0.62; 95% CI, 0.39–0.98), an increased risk of all-grade (RR = 1.69; 95% CI, 1.33–2.17) and high-grade (RR = 1.61; 95% CI, 1.02–2.57) neutropenia, all-grade (RR = 2.56; 95% CI, 1.37–4.80) and high-grade (RR = 3.63; 95% CI, 1.98–6.66) thrombocytopenia, and high-grade lymphopenia (RR = 1.84; 95% CI, 1.22–2.78). Stratified analysis by the presence or not of concomitant chemotherapy demonstrated similar risks.

Conclusions

Independent of cytotoxic chemotherapy, sorafenib has significant hematologic toxicities, with a decreased risk of anemia and increased risk of neutropenia, thrombocytopenia and lymphopenia.     

丹参注射液对深低温保存带瓣血管活性的影响

目的:探索丹参注射液对深低温保存带瓣血管活性的影响。方法:将家兔带瓣血管灭菌后,随机分为新鲜组、二甲基亚砜冻存对照组、二甲基亚砜和丹参注射液冻存研究组各10根;程控降温后液氮保存;于90 d、180 d后取出快速复温,置入培养液24 h;置入前后测定培养液中的葡萄糖含量并计算其差值。结果:新鲜组葡萄糖消耗量最高,冻存组随保存时间延长而逐渐减低;冻存研究组葡萄糖消耗量与新鲜组对比,差别无统计学意义(P0.05),但明显高于冻存对照组(P0.05);冻存对照组葡萄糖消耗量低于新鲜组,差别有统计学意义(P0.05)。结论:丹参注射液能更好地保存带瓣血管的活性,是一种更好的保护液。     

Long-chain polyunsaturated fatty acids may mutually benefit both obesity and osteoporosis

The overconsumption of n-6 polyunsaturated fatty acids (PUFA), resulting in a high ratio of n-6 to n-3 PUFA, may contribute to the increased pathogenesis of obesity and osteoporosis by promoting low-grade chronic inflammation (LGCI). As evidence suggests, both obesity and osteoporosis are linked on a cellular and systemic basis. This review will analyze if a relationship exists between LGCI, fat, bone, and n-3 PUFA. During the life cycle, inflammation increases, fat mass accumulates, and bone mass declines, thus suggesting that a connection exists. This review will begin by examining how the current American diet and dietary guidelines may fall short of providing an anti-inflammatory dose of the n-3 PUFA eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It will then define LGCI and outline the evidence for a relationship between fat and bone. Inflammation as it pertains to obesity and osteoporosis and how EPA and DHA can alleviate the associated inflammation will be discussed, followed by some preliminary evidence to show how mesenchymal stem cell (MSC) lineage commitment may be altered by inflammation to favor adipogenesis. Our hypothesis is that n-3 PUFA positively influence obesity and osteoporosis by reducing LGCI, ultimately leading to a beneficial shift in MSC lineage commitment. This hypothesis essentially relates the need for more focused research in several areas such as determining age and lifestyle factors that promote the shift in MSC commitment and if current intakes of EPA and DHA are optimal for fat and bone.     

Chromosomal Aberrations and Survival after Unrelated Donor Hematopoietic Stem Cell Transplant in Patients with Fanconi Anemia

Studies of chromosomal aberrations in blood or bone marrow of patients with Fanconi anemia (FA) have focused on their associations with leukemic transformation. The role of such abnormalities on outcomes after hematopoietic cell transplantation (HCT) is unclear. We used genome-wide single nucleotide polymorphism arrays to identify chromosomal aberrations in pre-HCT blood samples from 73 patients with FA who received unrelated donor HCT for severe aplastic anemia between 1991 and 2007. Outcome data and blood samples were available through the Center for International Blood and Marrow Transplant Research. For survival analyses, we used the Kaplan-Meier estimator to calculate the survival probabilities and the exact log-rank test to compare the survival differences across groups. Chromosomal aberrations were detected in 16 (22%) patients; most frequent were clonal copy loss in chromosome 7 (9.6%), clonal copy gains in the long arm (q) of chromosome 1 (chr1q⁺) (8.2%), and clonal or complete copy gains in the q arm of chromosome 3 (chr3q⁺) (8.2%). Seven (9.6%) patients had alterations in 3 or more chromosomes. Poor post-HCT overall survival (OS) was noted in patients with chr3q⁺?(P?=?.04), or those with abnormalities in ≥3 chromosomes (P?=?.03). The 1-year OS?was?0% versus 45% in patients with either alteration versus its absence. No statistically significant differences in OS were noted in patients carrying deletions in chr7 (1-year OS?=?29% versus 42%; log-rank P?=?.74). The study is limited by the small sample size. A larger, prospective study is warranted to validate our findings in light of recent improvement in transplant modalities and outcomes.     

五种中药对蛋白质非酶糖基化的抑制作用

观察了葛根、柴胡、地黄、人参和麦门冬5种药物对人血清白蛋白和大鼠晶状体蛋白的非酶糖基化的抑制作用。实验结果表明，除麦门冬外的4种药物对两种蛋白质的糖基化均有不同程度的抑制作用。对于人血清白蛋白糖基化，各种药物抑制率分别是对照组的；40％，43％，26％，30％和0；对于大鼠晶状体蛋白的糖基化，其抑制率分别是对照组的：46％、30％、33％、31％和0。实验结果提示，在这些中药中（除麦门冬外）可能存在着较有应用前景的蛋白非酶糖基化抑制剂成分。     

纤维喉镜在喉喘鸣诊断中的应用

目的:探讨纤维喉镜在喉喘鸣诊断中的应用价值.方法:回顾性分析130例以喉喘鸣为主要症状就诊的患儿的临床资料.130例患儿均接受纤维喉镜检查.结果:经纤维喉镜检查发现,130例患儿中先天性喉喘鸣73例,先大性喉噗2例,会厌囊肿5例,舌根部囊肿或肿块20例,喉气囊肿1例,喉乳头状瘤3例.一侧或舣侧披裂关节活动差9例.未发现任何异常17例.结论:单纯先灭性喉喘鸣易误诊,必须排除其他引起喉喘呜的疾病.建议将纤维喉镜作为喉喘呜患儿就诊时必须的常规检查,必要时可辅助喉部CT和(或)MRI检查.