高血压脑出血个体化手术治疗方案的探讨

目的评价中小骨窗开颅术,去大骨瓣减压术及锥颅血肿抽吸治疗高血压脑出血的疗效。方法通过对37例去大骨瓣减压开颅和68例早期显微镜下斜切口中小骨窗开颅术以及42例锥颅血肿抽吸治疗高血压脑出血的观察比较各组死亡率。结果发现去大骨瓣组死亡9例,死亡率为24.3%,植物生存4例,中小骨窗组死亡11例,死亡率为16.4%。锥颅组死亡22例,死亡率为52.1%。中小骨窗组与去大骨瓣组在血肿清除程度、死亡率和早期预后等方面相差无显著差异,而与锥颅组差异明显。结论显微镜下超早期中小骨窗开颅手术能满足在直视下清除血肿的需要,又有手术时间短,创伤小,术中出血少等优点。是当前手术治疗高血压性脑出血的有效选择。     

TMPRSS6 rs855791 modulates hepcidin transcription in vitro and serum hepcidin levels in normal individuals

The iron hormone hepcidin is inhibited by matriptase-2 (MT2), a liver serine protease encoded by the TMPRSS6 gene. Cleaving the bone morphogenetic protein (BMP) coreceptor hemojuvelin (HJV), MT2 impairs the BMP/son of mothers against decapentaplegic homologs (SMAD) signaling pathway, down-regulates hepcidin, and facilitates iron absorption. TMPRSS6 inactivation causes iron-deficiency anemia refractory to iron administration both in humans and mice. Genome-wide association studies have shown that the SNP rs855791, which causes the MT2 V736A amino acid substitution, is associated with variations of serum iron, transferrin saturation, hemoglobin, and erythrocyte traits. In the present study, we show that, in vitro, MT2 736(A) inhibits hepcidin more efficiently than 736(V). Moreover, in a genotyped population, after exclusion of samples with iron deficiency and inflammation, hepcidin, hepcidin/transferrin saturation, and hepcidin/ferritin ratios were significantly lower and iron parameters were consistently higher in homozygotes 736(A) than in 736(V). Our results indicate that rs855791 is a TMPRSS6 functional variant and strengthen the idea that even a partial inability to modulate hepcidin influences iron parameters and, indirectly, erythropoiesis.     

High prevalence of hyperuricemia in adolescent Taiwan aborigines

OBJECTIVE: To explore the prevalence and related factors of hyperuricemia among adolescent Taiwan aborigines in tribes with a high prevalence of adult gout, compared with adolescents of low prevalence aboriginal and non-aboriginal tribes. METHODS: The participants were aborigines and non-aborigines in Taiwan, age 12 to 15 years and free of gout. Each participant provided information on sex, age, and parents' tribal background as well as body weight and height. Serum samples were analyzed for biochemical markers. A logistic regression model was used to study factors related to hyperuricemia. RESULTS: In total 940 adolescents participated. The hyperuricemia rate in tribes with high gout prevalence (57.7%) was higher than in non-aborigines (48.2%) and in aboriginal tribes with low gout prevalence (34.0%). Factors statistically significantly related to hyperuricemia were tribe, sex, obesity, creatinine, and cholesterol levels in preliminary analysis. After adjustment by the logistic regression model, obese boys with higher creatinine were most likely to have hyperuricemia. Adolescents whose parents originated from tribes with high gout prevalence had a tendency to have hyperuricemia, and those aborigines from tribes with low gout prevalence had a low prevalence of hyperuricemia compared to non-aborigines. CONCLUSION: The prevalence of hyperuricemia in aboriginal adolescents mirrors the incidence of adult gout, implying a predisposition for adult gout in childhood, with genetic and/or environmental components presumably contributing to the differences between tribes; this may be of potential benefit to preventive efforts.     

糖尿病脑干听觉诱发电位分析

目的探讨脑干听觉诱发电位(BAEP)对糖尿病患者脑干功能损害的评定价值。方法对30例临床诊断为2型糖尿病的患者进行BAEP检测,并与20例正常组进行对照分析。结果糖尿病患者BAEP的异常率为63.33%,并与其病程呈正相关,但与血糖浓度无相关性。其中Ⅲ、Ⅴ波潜伏期(PL),Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ峰间期(IPL)较正常组延长,Ⅲ、Ⅴ波波幅降低,均有显著性差异(P<0.05)。结论BAEP对糖尿病脑干亚临床功能异常的诊断有重要意义。     

A case of refractory vasculitic ulcers in a systemic lupus erythematosus patient responding to rituximab and hyperbaric oxygen therapy

Large refractory vasculitic ulcers are not commonly seen in systemic lupus erythematosus (SLE) patients. We report a case of refractory vasculitic ulcers responding to rituximab, a monoclonal antibody directed against CD20 cells leading to prolonged B cell depletion. This treatment was initiated after treatment with high‐dose steroids and other immunosuppressants were ineffective/associated with significant side‐effects. Following treatment with rituximab, there was sustained clinical improvement and subsequent reduction of prednisolone dose. Rituximab was well‐tolerated. Concomitant methotrexate therapy and hyperbaric oxygen therapy (HBOT) may have aided the recovery of the patient’s vasculitic ulcers. This case and anecdotal reports have illustrated the efficacy and safety of rituximab in the treatment of refractory SLE‐related vasculitic ulcers. Further studies to determine the long‐term efficacy and side‐effects would be useful.     

Effect of ethnicity on disease activity and physical function in psoriatic arthritis in a multiethnic Asian population

Geographic differences in manifestation of psoriatic arthritis (PsA) could be related to differences in genetic or environmental factors. We aimed to compare the disease activity and functional status using validated outcome measures among patients with PsA of different ethnicities living in the same environment. We performed a cross-sectional study on consecutive patients with PsA classified by the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria from a single center. Sociodemographic data, clinical variables, and patient-reported outcomes were collected using a standardized protocol. Disease activities were assessed by validated composite scores: clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA), Composite Psoriatic Disease Activity Index (CPDAI), and minimal disease activity (MDA). Physical function was assessed with Health Assessment Questionnaire (HAQ) and the Medical Outcome Study Short-Form 36 (SF36) physical function subscales. Linear regression analyses were performed to identify variables associated with disease activities and physical function. Ninety-eight patients (51.5%, men) with mean (±SD) age and duration of PsA of 51.5 ± 13.8 and 5.5 ± 8.4 years were recruited. Indian was overrepresented compared with the national distribution of ethnicities. Compared to Chinese, Indian patients were more likely to be using biological therapies, have higher tender joint count, and worse enthesitis. Higher proportion of Indians had higher disease activity categories measured by cDAPSA, CPDAI, and MDA and had poorer physical function. In the multivariable analysis, ethnicity was significantly associated with HAQ and SF36-PF. Compared to Chinese, Indians with PsA living in the same environment had worse disease activity and physical function measured by validated outcomes.     

NCOA4-mediated ferritinophagy in macrophages is crucial to sustain erythropoiesis in mice

Nuclear receptor coactivator 4 (NCOA4) promotes ferritin degradation and Ncoa4-ko mice in a C57BL/6 background show microcytosis and mild anemia, aggravated by iron deficiency. To understand tissue-specific contributions of NCOA4-mediated ferritinophagy we explored the effect of Ncoa4 genetic ablation in the iron-rich Sv129/J strain. Increased body iron content protects these mice from anemia and, in basal conditions, Sv129/J Ncoa4-ko mice show only microcytosis; nevertheless, when fed a low-iron diet they develop a more severe anemia compared to that of wild-type animals. Reciprocal bone marrow (BM) transplantation from wild-type donors into Ncoa4-ko and from Ncoa4-ko into wild-type mice revealed that microcytosis and susceptibility to iron deficiency anemia depend on BM-derived cells. Reconstitution of erythropoiesis with normalization of red blood count and hemoglobin concentration occurred at the same rate in transplanted animals independently of the genotype. Importantly, NCOA4 loss did not affect terminal erythropoiesis in iron deficiency, both in total and specific BM Ncoa4-ko animals compared to controls. On the contrary, upon a low iron diet, spleen from wild-type animals with Ncoa4-ko BM displayed marked iron retention compared to (wild-type BM) controls, indicating defective macrophage iron release in the former. Thus, erythropoietin administration failed to mobilize iron from stores in Ncoa4-ko animals. Furthermore, Ncoa4 inactivation in thalassemic mice did not worsen the hematologic phenotype. Overall our data reveal a major role for NCOA4-mediated ferritinophagy in macrophages to favor iron release for erythropoiesis, especially in iron deficiency.     

Overview of transcatheter patent ductus arteriosus closure in preterm infants

Clinically significant patent ductus arteriosus (PDA) has been associated with significant morbidity in extremely low birth weight (ELBW) infants. Current management of ELBW infants with hemodynamically significant PDA includes supportive treatment, pharmacological therapy, and surgical ligation. All of these therapeutic options have their advantages and limitations. More recently, transcatheter PDA closure has been described as a viable option in this population. In this paper, we provide a comprehensive review of this emerging procedure.     

Does washing medical devices before and after use decrease bacterial contamination?: An in vitro study

Surface treatment of medical devices may be a way of avoiding the need for replacement of these devices and the comorbidities associated with infection. The aim of this study was to evaluate whether pre- and postcontamination washing of 2 prostheses with different textures can decrease bacterial contamination.The following microorganisms were evaluated: Staphylococcus aureus, Staphylococcus epidermidis, Proteus mirabilis and Enterococcus faecalis. Silicone and expanded polytetrafluoroethylene vascular prostheses were used and divided into 3 groups: prostheses contaminated; prostheses contaminated and treated before contamination; and prostheses contaminated and treated after contamination. Treatments were performed with antibiotic solution, chlorhexidine and lidocaine. After one week of incubation, the prostheses were sown in culture medium, which was incubated for 48 hours. The area of colony formation was evaluated by fractal dimension, an image analysis tool.The antibiotic solution inhibited the growth of S epidermidis and chlorhexidine decrease in 53% the colonization density for S aureus in for both prostheses in the pre-washing. In postcontamination washing, the antibiotic solution inhibited the growth of all bacteria evaluated; there was a 60% decrease in the colonization density of S aureus and absence of colonization for E faecalis with chlorhexidine; and lidocaine inhibited the growth of S aureus in both prostheses.Antibiotic solution showed the highest efficiency in inhibiting bacterial growth, especially for S epidermidis, in both washings. Lidocaine was able to reduce colonization by S aureus in post-contamination washing, showing that it can be used as an alternative adjuvant treatment in these cases.     

无创血管内皮舒张功能与冠心病的关联性

目的 :探讨无创血管内皮舒张功能与冠心病的关联性。方法 :经冠状动脉造影证实的冠心病患者 3 0例 ,分为冠心病 组 17例 ,冠心病 组 13例。对照组 2 0例 ,为健康查体者。肱动脉内皮依赖性舒张功能测定用无创高分辨超声法。结果 :13组基础血管内径无差异。 2反应性充血后肱动脉内径变化百分数 ,冠心病 组 （ 11± 4 ） %、冠心病 组 （ 6± 2 ） % ,对照组 （ 16± 5 ） % ,3组间差异显著 （ vs P<0 .0 1; , vs对照组均 P<0 .0 1）。 3含化硝酸甘油后肱动脉内径变化百分数 ,冠心病 组 （ 17± 5 ） %、冠心病 组 （ 14± 3 ） % ,对照组 （ 2 5± 7） % , 组 , 组与对照组比较差异显著 （均 P<0 .0 1） ; 组与 组间无显著差异。结论 :用高分辨超声测定的肱动脉内皮依赖性舒张功能与冠心病患者冠状动脉粥样硬化程度有关联