Plasma Exchange Versus Double Filtration Plasmapheresis in the Treatment of Guillain‐Barré Syndrome

Abstract: Previous studies have shown that both plasma exchange (PE) and double filtration plasmapheresis (DFPP) are effective treatments in Guillain‐Barré syndrome (GBS). Whether PE and DFPP have similar effects in GBS is not clear. This report compares the therapeutic effectiveness of PE and DFPP in GBS patients treated in 3 major hospitals in northern Taiwan. A total of 102 patients were included in this survey, including 39 with PE (hereafter PE group) and 63 with DFPP (hereafter DFPP group). Both groups showed significant improvement of disability scores after treatment. However, time to onset of effect was shorter (5.6 ± 3.5 versus 7 ± 3.4 days, p < 0.05), and changes of disability scores were more prominent (1.3 ± 0.8 versus 0.8 ± 0.8, p < 0.05) in the PE group than the DFPP group. Mortality and outcome after 6 months were not different between the 2 groups. In conclusion, both PE and DFPP are effective treatments in GBS. PE was superior to DFPP in short‐term effectiveness. The long‐term effectiveness was not different.     

Correlation between the platelet‐to‐lymphocyte ratio and diabetic foot ulcer in patients with type 2 diabetes mellitus

ObjectiveTo investigate the correlation between the platelet‐to‐lymphocyte ratio (PLR) and diabetic foot ulcer (DFU) in patients with type 2 diabetes mellitus (T2DM).MethodFrom January 2018 to August 2019, 206 patients with T2DM admitted to the Central Hospital of Wuhan, China, were enrolled in this study, including 104 patients with DFU (DFU group) and 102 patients without DFU (T2DM group). During the same period, 90 healthy subjects were randomly screened as normal controls (NC group). The correlation between PLR and DFU in patients with T2DM was explored by comparing the PLR of the subjects in the three groups.ResultsThe PLRs of the DFU and T2DM groups were higher than that of the NC group, whereas the PLR of the DFU group was higher than that of the T2DM group (p < 0.05). PLR was positively correlated with the Wagner DFU grade (p < 0.001). Based on logistic regression analysis, PLR was found to be an independent risk factor for DFU (OR =1.029, 95% CI: 1.019 ~ 1.039, p < 0.001). The receiver operating characteristic curve analysis of the PLR showed that the area under the curve of the PLR for predicting diabetic foot ulcer was 0.776 (p < 0.001), and the analysis determined that the optimal critical value of the PLR for predicting DFU was 147.6.ConclusionThe PLR is significantly elevated in patients with DFU and positively correlated with the Wagner DFU grade, which might be a valuable marker for early diagnosis and assessment of severity of DFU.     

Skeletal class II malocclusion caused by mouth breathing in a pediatric patient undergoing treatment by interceptive guidance of occlusion

A 7-year 10-month-old boy was evaluated for mouth breathing and snoring habits. Examination revealed soft convex tissues, maxillary protrusion, mandibular retrusion, and a class II sagittal osteofascial pattern. The patient failed a water holding test. He was clinically diagnosed with skeletal class II malocclusion caused by mouth breathing. Under interceptive guidance of occlusion (iGo), the malocclusion improved with fixed maxillary expansion using functional appliances and interventional treatment of mouth breathing by lip closure exercises. These treatments enabled the patient to gradually return to nasal breathing and guided him to develop physiological occlusion for a coordinated jaw-to-jaw relation. At the 5-year 2-month post-correction follow-up visit (at the age of 13 years), the patient had stable occlusion, a coordinated osteofascial pattern, and normal dentition, periodontium, and temporomandibular joints.     

Association between PARK16 and Parkinson's disease in the Han Chinese population: a meta-analysis

PARK16 was reported to alter the risk for Parkinson's disease (PD) in the Japanese population. However, its role in Han Chinese PD patients has not been well established. Herein, we investigated the effect of 4 single-nucleotide polymorphisms (SNPs) within the PARK16 locus, including rs823128, rs947211, rs823156, and rs11240572, on the risk of PD by genotyping 497 Taiwanese patients with PD and 500 age-matched control subjects. The results were then meta-analyzed with available genetic association studies in the same population. The meta-analysis showed that PD patients demonstrated a lower frequency of the rs823128 G allele (11.93%) than control subjects (14.04%; odds ratio [OR] 0.83, 95% confidence interval [CI] 0.72–0.96, p = 0.010). The frequency of the rs947211 A allele (40.35%) in PD patients was lower than in control subjects (43.01%; OR 0.90, 95% CI 0.80–0.99, p = 0.047). The rs823156 G allele was less frequently seen in PD patients (17.32%) than in control subjects (21.35%; OR 0.77, 95% CI 0.69–0.86, p < 0.001). A lower frequency of the rs11240572 A allele was found in PD patients (14.01%) than in control subjects (17.66%; OR 0.76, 95% CI 0.66–0.88, p < 0.001). Our results indicate a robust protective effect of PARK16 in Han Chinese PD patients. Functional approaches are needed to elucidate the effects of these SNPs on the regulation of gene expression.     

Differentiation between Clear Cell Sarcoma of the Kidney and Wilms' Tumor with CT

ObjectiveClear cell sarcoma of the kidney (CCSK) is the second-most common but extremely rare primary renal malignancy in children after Wilms'' tumor. The aims of this study were to evaluate the imaging features that could distinguish between CCSK and Wilms'' tumor and to assess the features with diagnostic value for identifying CCSK.Materials and MethodsWe reviewed the initial contrast-enhanced abdominal-pelvic CT scans of children with CCSK and Wilms'' tumor between 2010 to 2019. Fifty-eight children (32 males and 26 females; age, 0.3–10 years), 7 with CCSK, and 51 with Wilms'' tumor, were included. The maximum tumor diameter, presence of engorged perinephric vessels, maximum density of the tumor (Tmax) of the enhancing solid portion, paraspinal muscle, contralateral renal vein density, and density ratios (Tmax/muscle and Tmax/vein) were analyzed on the renal parenchymal phase of contrast-enhanced CT. Fisher''s exact tests and Mann-Whitney U tests were conducted to analyze the categorical and continuous variables, respectively. Logistic regression and receiver operating characteristic curve analyses were also performed.ResultsThe age, sex, and tumor diameter did not differ between the two groups. Engorged perinephric vessels were more common in patients in the CCSK group (71% [5/7] vs. 16% [8/51], p = 0.005). Tmax (median, 148.0 vs. 111.0 Hounsfield unit, p = 0.004), Tmax/muscle (median, 2.64 vs. 1.67, p = 0.002), and Tmax/vein (median, 0.94 vs. 0.59, p = 0.002) were higher in the CCSK compared to the Wilms'' group. Multiple logistic regression revealed that engorged vessels (odds ratio 13.615; 95% confidence interval [CI], 1.770–104.730) and Tmax/muscle (odds ratio 5.881; 95% CI, 1.337–25.871) were significant predictors of CCSK. The cutoff values of Tmax/muscle (86% sensitivity, 77% specificity) and Tmax/vein (71% sensitivity, 86% specificity) for the diagnosis of CCSK were 1.97 and 0.76, respectively.ConclusionPerinephric vessel engorgement and greater tumor enhancement (Tmax/muscle > 1.97 or Tmax/vein > 0.76) are helpful for differentiating between CCSK and Wilms'' tumor in children aged below 10 years.     

超声引导下经皮肺穿刺并发症及相关因素分析

【摘要】 目的 分析超声引导下经皮肺穿刺活检术并发症及其影响因素。方法 2017年6月至2020年1月于超声引导下经皮肺穿刺活检的病例193例,统计并分析并发症的发生与患者的性别、年龄、病灶部位、大小、病理结果、穿刺方式及切割次数的关系。结果 193例中出现并发症的患者共42例（21.8%）。其中气胸14例（7.3%）,咯血14例（7.3%）,胸膜反应12例（6.2%）,穿刺部位疼痛5例（2.6%）。并发症相关因素分析可知:并发症的发生与患者的年龄、病灶部位及病灶大小相关（P＜0.05）。结论 患者的年龄、病灶部位、大小会影响超声引导下经皮肺穿刺活检并发症的发生率。     

一例早发癫痫性脑病42型患儿的临床表型及基因变异分析

目的探讨一例早发癫痫性脑病42型患儿的基因型与表型特征。方法详细询问患儿的病史,结合其临床表型、影像学及遗传学特征进行临床诊断,并对其父母进行Sanger测序验证,明确致病变异的来源。结果患儿无意识头向一侧轻度歪斜,眼球向同侧斜视,脑电图异常放电。磁共振成像显示左额后皮层可疑异常信号,伴右侧上颌窦及筛窦炎症。全外显子组测序提示患儿携带CACNA1A基因c.5789G>A杂合变异,Sanger测序提示父母双方并未携带相同的变异,提示其为新发变异。结论先证者CACNA1A基因c.5789G>A杂合变异可能是导致其早发癫痫性脑病42型的原因。     

牙周病患者治疗前后血清IL-2、SIL-2R、SOD、LPO和GSH-PX检测的临床评价

目的:探讨牙周病患者治疗前后血清IL-2、SIL-2R和SOD、LPO和GSH-PX水平的变化及临床意义。方法:应用放射免疫分析、酶联法和生化法对40例牙周病患者进行了治疗前后血清IL-2、SIL-2R、SOD、LPO和GSH-PX检测,并与35名正常人作比较。结果:牙周病患者在治疗前血清IL-2、SOD、GSH-PX水平非常显著地低于正常人组(P<0.01),而SIL-2R、LPO水平又非常显著地高于正常人组(P<0.01),经治疗3个月后则与正常人组比较无显著性差异(P>0.05)。血清IL-2水平与SOD、GSH-PX水平呈正相关(r=0.6011、0.5782,P<0.01),而与SIL-2R、LPO水平呈显著负相关(r=-0.4814、-0.5051,P<0.01)。结论:检测牙周病患者血清IL-2、SIL-2R、SOD、LPO和GSH-PX水平的变化对了解病情、观察预后均有一定的临床价值。