病理诊断与失误

文章阐述了病理诊断作为最具权威性的金标准在基础医学与临床医学间的桥梁作用。病理学在诊断方法上吸收了解剖、组织胚胎、生化、微生物等基础知识，从细胞水平认识疾病本质，进而作出诊断与鉴别诊断。说明病理的发展对现代医学具有很大的推动作用，并同时提出病理误诊的原因、后果及减少误诊的措施。     

合并尺骨茎突骨折对桡骨远端骨折患者桡尺远侧关节功能影响的Meta分析

目的:评价合并尺骨茎突骨折对桡骨远端骨折患者桡尺远侧关节功能的影响。方法:计算机检索PubMed、Embase、Cochrance library、中国知网、万方数据库中所有对比合并或不合并尺骨茎突骨折的桡骨远端骨折患者桡尺远侧关节功能的随机对照或非随机对照临床试验文献,治疗方法为切开复位掌侧钢板螺钉内固定或跨关节的外固定架固定。检索时限为建库至2019年8月31日。筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Revman5.3软件进行Meta分析。结果:共纳入5篇文献。Meta分析结果显示,合并和不合并尺骨茎突骨折患者(尺骨茎突骨折组和无尺骨茎突骨折组)的腕关节屈曲活动度、背伸活动度比较,组间差异均无统计学意义[屈曲活动度:P=0.850,I^2=0%;WMD=-0.05,95%CI(-1.99,1.88),P=0.960。背伸活动度:P=0.990,I^2=0%;WMD=-0.67,95%CI(-1.35,2.68),P=0.520];2组患者前臂旋前活动度、前臂旋后活动度比较,组间差异均无统计学意义[前臂旋前活动度:P=0.090,I^2=51%;WMD=-1.56;95%CI(-4.64,1.53),P=0.320。前臂旋后活动度:P=0.620,I^2=0%;WMD=-0.39,95%CI(-2.19,1.40),P=0.670];2组患者的上肢功能障碍评分比较,差异无统计学意义[P=0.270,I^2=19%;WMD=3.72,95%CI(-0.20,7.65),P=0.060]。结论:现有的证据表明,合并尺骨茎突骨折不会对桡骨远端骨折患者桡尺远侧关节功能产生影响。     

对一种强化碱性戊二醛消毒剂的毒理学评价

为了解四环牌强化碱性戊二醛的安全性,进行了急性经口毒性、蓄积毒性、皮肤变态反应、小鼠骨髓嗜多染红细胞微核和精子畸形试验。结果,该剂对小鼠经口LD50为6329mg/kg（体重）,蓄积系数K>5;豚鼠皮肤变态反应试验未出现过敏反应;试验用戊二醛剂量诱导PCE微核细胞率与阴性对照组差异无统计学意义（P>0.05）,对小鼠精子畸形发生率无影响。因此,在本实验条件下,强化碱性戊二醛为实际无毒、弱蓄积毒性。极轻致敏性物质,没有致突变作用。     

Relationship between effort–reward imbalance and hair cortisol concentration in female kindergarten teachers

Objective

The present study aims to investigate the relationship between effort–reward imbalance and hair cortisol concentration among teachers to examine whether hair cortisol can be a biomarker of chronic work stress.

Methods

Hair samples were collected from 39 female teachers from three kindergartens. Cortisol was extracted from the hair samples with methanol, and cortisol concentrations were measured with high performance liquid chromatography–tandem mass spectrometry. Work stress was measured using the effort–reward imbalance scale.

Results

The ratio of effort to reward showed significantly positive association with hair cortisol concentration.

Conclusion

The cortisol concentration in the system increases with the effort–reward imbalance. Measurement of hair cortisol can become a useful biomarker of chronic work stress.     

Primary alveolar soft part sarcoma arising from the cerebellopontine angle

Introduction

Alveolar soft part sarcoma (ASPS), a rare soft tissue malignant neoplasm, frequently metastasizes to the brain. However, primary intracranial ASPS is extremely rare. We present a case of primary intracranial ASPS arising from the cerebellopontine angle (CPA) without demonstrable systemic lesions.

Case report

An 11-year-old girl presented with a recurrent tumor in the right CPA after a partial resection and radiation therapy (RT). Near-total resection with a minimal tumor left in the jugular foramen was performed. The pathological diagnosis was ASPS. There was no evidence of primary extracranial tumors. She underwent adjuvant chemotherapy and gamma knife surgery. At 29 months after the second surgery, magnetic resonance imaging revealed multifocal enhancing lesions at the prepontine cistern, right CPA and medulla oblongata, despite intensive treatment. However, extracranial metastasis was not noted. This case suggested a poor outcome of primary intracranial ASPS, similar to extracranial ASPS.     

Usefulness of contrast enhanced FLAIR imaging for predicting the severity of meningitis

The aim of this study was to evaluate whether contrast enhanced fluid attenuated inversion recovery (CE-FLAIR) imaging can be used to predict the severity of meningitis based on leptomeningeal enhancement (LE) score and cerebrospinal fluid signal intensity (CSF-SI) on CE-FLAIR. We retrospectively analyzed data collected from 43 consecutive patients admitted to our hospital due to meningitis. Clinical factors including initial Glasgow Coma Scale (GCS) score, CSF glucose ratio, log CSF protein, log CSF WBC, and prognosis were evaluated. The LE score was semi-quantitatively scored, and we evaluated CSF-SI ratio at the interpeduncular or quadrigerminal cisterns on CE-FLAIR. We evaluated the differences in clinical variables, LE scores and CSF-SI ratios between the recovery and the complication group. We assessed the correlation between clinical variables, LE scores and CSF-SI ratios. The values of log CSF protein, CSF-SI ratio, and LE score were significantly higher in the complication group (p value <0.05). GCS score and CSF glucose ratio were significantly lower in the complication group (p value <0.01). The LE scores had significant negative correlation with GCS scores and CSF glucose ratios (p value <0.001). The LE score was significantly positively correlated with the value of log CSF protein and CSF-SI ratio (p value <0.01). The CSF-SI ratio was negatively correlated with GCS score and CSF glucose ratio (p value <0.01). The CSF-SI ratio was positively correlated with the value of log CSF protein (p value <0.05). Our results suggest that LE score and CSF-SI ratio are well correlated with clinical prognostic factors. We may predict the clinical severity of meningitis by using LE scores and CSF-SI ration on CE-FLAIR imaging.     

Acoustical enrichment during early postnatal development changes response properties of inferior colliculus neurons in rats

The structure and function of the auditory system may be influenced by acoustic stimulation, especially during the early postnatal period. This study explores the effects of an acoustically enriched environment applied during the third and fourth week of life on the responsiveness of inferior colliculus neurons in rats. The enrichment comprised a spectrally and temporally modulated complex sound reinforced with several target acoustic stimuli, one of which triggered a reward release. The exposure permanently influenced neuronal representation of the sound frequency and intensity, resulting in lower excitatory thresholds at neuronal characteristic frequency, an increased frequency selectivity, larger response magnitudes, steeper rate–intensity functions and an increased spontaneous activity. The effect was general and non‐specific, spanning the entire hearing range – no changes specific to the frequency band of the target stimuli were found. The alterations depended on the activity of animals during the enrichment – a higher activity of rats in the stimulus–reward paradigm led to more profound changes compared with the treatment when the stimulus–reward paradigm was not used. Furthermore, the exposure in early life led to permanent changes in response parameters, whereas the application of the same environment in adulthood influenced only a subset of the examined parameters and had only a temporary effect. These findings indicate that a rich and stimulating acoustic environment during early development, particularly when reinforced by positive feedback, may permanently affect signal processing in the subcortical auditory nuclei, including the excitatory thresholds of neurons and their frequency and intensity resolution.