化脓性胸椎炎伴硬膜外脓肿突发截瘫1例

患者,女,70岁,因"腰背痛伴发热40d,加重7d"入院。40d前出现高热、咳嗽、咳痰,无胸痛,有腰背部持续性酸痛,休息后无缓解,下肢无麻木、疼痛感,活动可。胸部CT示:肺部感染。X线片检查示:T12椎体楔形改变(见图1a)。诊断为"T12压缩性椎体骨折和肺部感染",予头孢曲松针静滴,口服骨化三醇片,体温在38.0～38.5℃,咳嗽、咳痰减少,腰背痛未     

Environmental discontinuity hypothesis: Buffer dysfunctions as a source of human disease

Adaptive physiologic buffers enable organisms to respond to environmental variation with appropriate plasticity. Modern humans have substantially remodeled their environment such that many interactions with the environment have become relatively discontinuous functions compared to the past. Examples include sunlight, temperature, and altitude. We propose that environmental discontinuity represents a Darwinian maladaptation and may promote disease by inducing buffer dysfunctions. Skin pigmentation is an adaptive, dynamic buffer that normalizes sunlight exposure to balance the potential harm of damaging rays with the importance of sunlight in driving systemic biologic functions such as melatonin and vitamin D. Due to lifestyle characteristics such as indoor-outdoor living, well-intended sun-avoidance campaigns, and inhomogeneous use of apparel and sunblock techniques, modern humans increasingly experience sunlight variation as a discontinuous function. The resulting skin pigmentation buffer dysfunction may promote diseases associated with over- or under-exposure to sunlight, the most striking example being melanoma. In addition to promoting discontinuity of sunlight exposure, sun-avoidance campaigns may undermine sun-dependent biologic pathways such as melatonin and vitamin D that appear to protect against cancer. These issues may partly explain the rise in melanoma rates despite the implementation of sun-avoidance campaigns. Also discussed is the potential role that discontinuous temperature variation associated with modern lifestyles plays in diseases such as viral infection, heart failure, and acute coronary syndromes. Acute discontinuous changes in pressure and oxygen levels related to air travel may contribute to autonomic dysfunction, venous thromboembolism, and viral infections. Therapeutic implications are discussed.     

Unhappy meal: how our need to detect stress may have shaped our preferences for taste

Conventional wisdom says that our preferences for particular tastes evolved to ensure an adequate instinctual intake of metabolic resources. Yet we discern scant taste in many vital dietary components, such as vitamins, minerals, co-factors, essential fatty acids and amino acids. We propose that taste preferences evolved to serve a secondary function--that of xenohormesis. Stress causes organisms to convert complex sugars to simple sugars, as seen during fruit ripening, and to increase the proportion of high-energy saturated fats relative to unsaturated fats, as seen among farmed livestock. The presence of dietary simple sugars, saturated fats, and salt within an organism may echo its stress experience--an experience assimilated by others when consumed. As each successive consumer in the food chain incorporates the stress phenotypes of its dietary components, cues for stress may accumulate in a game of "you-are-what-you-eat". Detection of environmental stress embedded in diet may promote adaptive phenotype remodeling such as caloric hoarding to contend with potential ecologic challenges. The phenotype remodeling may be the result of direct stress signaling properties of fats, sugars, and salt. Since food ecosystems typically exhibit seasonality in composition, early detection of cues of ecologic stress during autumn, such as dehydration, lowered ambient temperatures, and impending resource scarcity, likely confers advantages in fitness. Taste preferences may represent a form of "Darwinian rubbernecking. Much like paying attention to vignettes of violence and trauma, recognizing proxies of ecologic stress and adapting accordingly may yield fitness advantages. Many aspects of agricultural modernization may increase the level of stress embedded in the food chain, catering to pre-existing taste preferences in a form of illegitimate signaling. Globalization and technology have transformed the dietary experience of autumn--when the food chain undergoes stress and therefore tastes the best--into a year-round bacchanal. Instead of experiencing ecologic stress through their diet in a seasonal pattern, modern humans have become creatures of chronic stress. Many human conditions related to stress dysfunctions may partly arise from maladaptive consumption of stressed foods. We anticipate that low-stress and stress-free food may have therapeutic potential in the treatment of diseases and the promotion of health.     

New and efficient method using Saccharomyces cerevisiae mutants for identification of siderophores produced by microorganisms

The separation and identification of siderophores produced by microorganisms is a time-consuming and an expensive procedure. We have developed a new and efficient method to identify siderophores using well-established Saccharomyces cerevisiae deletion mutants. The Δfet3,arn strains fail to sustain growth, even when specific siderophores are supplied, and mutants are siderophore-specific: Δfet3,arn2 for triacetylfusarinine C (TAFC), Δfet3,arn1,sit1 for ferrichrome (FC), and Δfet3,sit1 for ferrioxamine B (FOB). The culture broth of Fusarium graminearum was separated by HPLC, and each peak was subjected to a plate assay using S. cerevisiae mutants. We have found that each peak contained specific siderophores produced by F. graminearum, and these coincided with reference siderophores. This method is quite novel because nobody tried this method to identify the siderophores. Furthermore, this method will save time and cost in the identification of siderophores produced by microorganisms.     

Anal canal carcinoma: experience from a single Korean institution

PURPOSE: The clinical features, treatment modality approaches in clinical practice, and prognostic factors for anal canal carcinoma patients were retrospectively analyzed. MATERIALS AND METHODS: Between October 1994 and December 2005, 50 patients with anal canal cancer were treated at Samsung Medical Center, Seoul, Korea. RESULTS: After a median follow up of 37.8 months (range, 6.6-136.1 months), the 5-year and 10-year survival rates for the 38 patients with early and locally advanced squamous and cloacogenic carcinoma (squamous cell carcinoma and cloacogenic carcinoma) were 74.8% and 66.5%, respectively. The 5-year survival and disease-free survival rates (DFS) of the 31 patients who received chemoradiation therapy (CRT) were 83.6% and 74.3%, respectively. The overall and DFS could not be determined for the adenocarcinoma group due to the small number of cases (n=8). Univariate analysis showed that tumor size (p=0.04) and inguinal node status (p=0.04) significantly influenced patient survival in patients with squamous cell and cloacogenic carcinomas. Furthermore, univariate analysis also showed that, inguinal node status influenced patient survival in the adenocarcinoma group. Multivariate analysis showed that inguinal node metastasis is a single independent prognostic variable for survival (p=0.04) in patients with squamous cell and cloacogenic carcinomas. CONCLUSION: Combined CRT has been adopted as standard treatment with outcomes that are comparable to those reported in randomized clinical trials. Due to the rarity and complexity of anal canal carcinoma, interdepartmental cooperation is required for disease treatment. Thus, proper treatment of patients should incorporate a team-approach and should be available to as many patients as possible.     

Matrix metalloproteinase-9 activity is associated with poor prognosis in T3-T4 node-negative colorectal cancer

Reversion-inducing cysteine-rich protein with Kazal motifs (RECK) is a novel membrane-anchored matrix metalloproteinase (MMP) inhibitor. RECK, MMP-2, and MMP-9 are believed to play crucial roles in tumor progression. This study was designed to examine the prognostic value of RECK, MMP-2, and MMP-9 in conjunction with other clinicopathologic factors in patients of T3-T4 node-negative colorectal cancer. RECK and MMP expression was observed using immunohistochemical analysis of the primary tumor from 89 patients with curatively resected T3-4 N0 colorectal cancer retrospectively. High RECK expression was observed in 51 cases, whereas expression was low in the other 38 cases. MMP-2 and MMP-9 expression was positive in cancer cells in 24 and 33 cases, respectively. RECK and MMP-2 expression was not significantly associated with any clinicopathologic factors. However, expression of MMP-9 was correlated with tumor location. A statistically significant inverse correlation was found between RECK and MMP-2 expression, and a statistically significant correlation was found between MMP-2 and MMP-9 expression. However, no association between RECK and MMP-9 expression was observed. Univariate analysis demonstrated that rectal tumor location, preoperative carcinoembryonic antigen more than 5 ng/mL, positive lymphatic invasion, less than 12 dissected lymph nodes, and positive MMP-9 expression were poor prognostic factors of disease-free survival. A multivariate analysis confirmed that enhanced MMP-9 expression was an independent and significant factor for prediction of a poor prognosis. In addition, positive lymphatic invasion and less than 12 dissected lymph nodes were significant negative prognostic factors. In conclusion, MMP-9 status represents a novel prognostic factor in evaluation of T3-T4 node-negative colorectal cancer.     

超声处理在含骨或沙砾体病理标本脱钙中的应用

病理制片是确诊含有骨化组织及沙砾体组织疾病的主要技术手段之一。常规方法脱钙需4～10h,超声处理可使脱钙时间大大缩短,只需25～60min。我们以对脑膜瘤组织进行脱钙为例,对应用超声处理进行脱钙方法概述如下。[第一段]