A Case of Upper Limb Compartment Syndrome following Snake Envenomation Measure Twice,Cut Once

We report a case of a 16-year old male patient who sustained a poisonous bite from a mapepire balsain snake on the dorsum of his left hand. The subject presented within one hour of envenomation and subsequently developed clinical features of acute compartment syndrome in the involved upper limb. Early diagnosis and emergency fasciotomy effectively treated his condition. Aggressive physiotherapy coupled with this ensured best functional outcome.     

Longitudinal studies of regional cerebral metabolism in Alzheimer's disease

Measurement of cerebral glucose metabolism in six patients with Alzheimer's disease using positron emission tomography demonstrated that hypometabolism remained relatively more severe in parietal cortex than in frontal cortex over time. Lateral metabolic asymmetries were preserved in less severely involved brain regions, but were less stable in parietal cortex.     

Vascular air embolism: A rare complication of nasal CPAP

Abstract: A preterm infant developed bilateral tension pneumothoraces and extensive vascular air embolism 6 h after being commenced on nasal continuous positive airway pressure (CPAP). Neonatal clinicians should be aware that catastrophic vascular air embolism could occur in infants receiving nasal CPAP, a modality of respiratory support conventionally considered non-invasive and 'safe'.     

Distinctive features of severe SARS-CoV-2 pneumonia

The coronavirus disease 2019 (COVID-19) pandemic is among the most important public health crises of our generation. Despite the promise of prevention offered by effective vaccines, patients with severe COVID-19 will continue to populate hospitals and intensive care units for the foreseeable future. The most common clinical presentation of severe COVID-19 is hypoxemia and respiratory failure, typical of the acute respiratory distress syndrome (ARDS). Whether the clinical features and pathobiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia differ from those of pneumonia secondary to other pathogens is unclear. This uncertainty has created variability in the application of historically proven therapies for ARDS to patients with COVID-19. We review the available literature and find many similarities between patients with ARDS from pneumonia attributable to SARS-CoV-2 versus other respiratory pathogens. A notable exception is the long duration of illness among patients with COVID-19, which could result from its unique pathobiology. Available data support the use of care pathways and therapies proven effective for patients with ARDS, while pointing to unique features that might be therapeutically targeted for patients with severe SARS-CoV-2 pneumonia.     

纳米羟基磷灰石／壳聚糖复合人工骨的成骨及再血管化

目的:通过纳米羟基磷灰石/壳聚糖(N-HA/CS)复合骨形态发生蛋白(BMP)制备N-HA/CS-BMP复合人工骨,初步了解其植入后成骨与血管长入之间的关系,以及复合人工骨的孔径对再血管化的影响。方法:①材料的制备:采用共沉淀法、粒子沥滤法制备N-HA/CS多孔复合材料,孔隙率为85%,孔径为100￣500μm;通过N-HA/CS与氧化锌粉末按质量比为8∶1的方式混合制备成致密复合材料;然后分别复合BMP制备N-HA/CS-BMP复合人工骨。②实验过程:20只新西兰兔,在兔双后肢胫骨近段内侧用直径为3.5mm手摇钻头钻2个孔制备骨缺损模型。随机取15只兔,右侧植入2块多孔N-HA/CS-BMP复合人工骨为多孔N-HA/CS BMP组,左侧植入2块致密N-HA/CS-BMP复合人工骨为致密N-HA/CS BMP组;另5只兔右侧植入2块多孔N-HA/CS为多孔N-HA/CS组,左侧植入2块致密N-HA/CS为致密N-HA/CS组。③观察指标:术后4,6,8周麻醉后墨汁灌注处死动物取出标本,行大体观察、X射线检查、组织学观察、Ⅰ型胶原免疫组化染色、显微计算机图像采集分析,了解各组成骨能力、血管化程度、复合人工骨的成骨与血管化之间的相互关系。结果:①一般情况:术后死亡2只动物,2只一侧肢体发生骨折,伤口均于2周左右愈合,未发生感染。②X射线检查:术后4,6周显示植入孔明显,材料与骨之间有密度减低的透光环,8周材料与骨结合紧密,透光环消失。③组织学观察:术后4,6周的材料内的炎性反应较重,主要是白细胞和巨噬细胞,8周的材料内炎性反应减轻;8周壳聚糖大部分降解,从而显现出羟基磷灰石的多孔结构。④显微计算机图像分析:多孔N-HA/CS BMP组血管密度和新生骨小梁面积大于其他3组(P<0.05),多孔N-HA/CS BMP组血管密度与骨小梁面积呈直线正相关关系(r=0.483,P=0.003)。⑤Ⅰ型胶原免疫组织化学染色显示结果支持显微计算机图像分析结果。结论:复合人工骨的成骨与血管化呈直线正相关关系,复合人工骨的成骨与血管化在早期是随着材料降解而完成的,多孔结构在晚期对血管化和成骨有利。     

Massive subdural haematoma: An unusual complication of septicaemia in preterm very low birthweight infants

Non-traumatic massive subdural haematoma is a rare condition in newborn infants and is usually associated with hereditary coagulation disorders or congential vascular malformation. Its occurrence in preterm very low birthweight infants secondary to systemic bacterial infection has not been reported. We describe two extremely preterm neonates who developed massive subdural haematoma as a result of Gram-negative septicaemia and disseminated intravascular coagulation. Both infants suffered severe parenchymal cerebral injury and hydrocephalus. Clinicians should be aware of this unusual and catastrophic complication if a very low birthweight infant with severe sepsis and disseminated intravascular coagulation suddenly deteriorates despite successful treatment with antibiotics. Radiological imaging by cranial ultrasound or computed tomography scanning should be routinely considered in all such infants for the detection of intracranial bleeding.     

Primary prevention in a high-risk group: smoking habits in adolescents with homozygous alpha-1-antitrypsin deficiency (ATD)

The serious form of alpha-1-antitrypsin deficiency (ATD) Pi ZZ strongly predisposes the individual for pulmonary emphysema and premature death in adulthood, especially if exposed to tobacco smoking. General screening of all new-born children was conducted in Sweden during 1972–1974, the major purpose being to reduce exposure of the child to parental smoking while growing up and to prevent the child from starting to smoke. Sixty-one children with ATD neonatally identified through mass-screening, and their families, have been compared with a demographically matched control group regarding smoking habits, as studied through interviews and questionnaires on two occasions. When the children were 5–7 years old, the smoking rates among parents of the ATD children and especially among the ATD fathers exceeded smoking rates for controls. Thirteen years later no differences in parental smoking were found between the groups. At 18–20 years of age the ATD children reported smoking significantly less than the control children (p < 0.05). From the perspective of prevention, the goal of the neonatal screening to reduce the smoking rates among the parents of the ATD children was not attained, while it was achieved among the ATD children. The results indicate that a screening program with early detection of ATD effectively prevents adolescent children from starting to smoke. From ethical, medical and psychological points of view, a voluntary screening program for ATD in pre-adolescence is recommended.     

Quantitative NMR measurements of hippocampal atrophy in Alzheimer's disease

Nuclear magnetic resonance (NMR) imaging was employed to study 10 patients with Alzheimer's disease (AD) and seven healthy elderly control subjects. Coronal sections were used to make volumetric measurements of the hippocampus, ventricles, subarachnoid space, and brain parenchyma. The hippocampal volume (normalized relative to the size of the lenticular nucleus) was reduced by 40% in the AD group compared to the controls, with no overlap between the two groups. Overall measures of brain atrophy and ventricular and sulcal enlargement also showed significantly different group means, although with overlap between the two groups. Hippocampal atrophy did not correlate with either overall brain atrophy or dementia severity, although the degree of brain atrophy was correlated with dementia severity. These results show that NMR is capable of providing in vivo quantification of diminished hippocampal size in AD which is not correlated with overall brain atrophy and which may differentiate AD from normal aging.     

Clinical effectiveness and safety experience with efalizumab in the treatment of patients with moderate-to-severe plaque psoriasis in Taiwan: results of an open-label, single-arm pilot study

Background No clinical trial of efalizumab has been conducted in Asia. Objective To determine the efficacy and safety of efalizumab in Taiwanese patients with psoriasis. Methods This is an open‐label, single‐arm pilot study conducted at two centres. Patients were given 1 mg/kg efalizumab subcutaneously once a week for 12 weeks and were then followed up for a further 12 weeks. Results A total of 49 patients participated in the study. The median improvement in Psoriasis Area and Severity Index (PASI) during the treatment period was 19.6%, and a ≥ 50% improvement in PASI was seen in 20.4%. Rebound was seen in 17.8% of patients, and anti‐efalizumab antibodies were detected in 41% of patients. The most frequent adverse events were headache (34.7%), arthralgia/arthritis (28.6%), psoriasis events (new form/exacerbation; 26.5%) and pruritus (22.4%). Conclusions This small pilot study indicated that efalizumab was effective in improving psoriasis symptoms in Taiwanese patients, with no new safety issues identified.