Real-World Data Regarding Satisfaction to Botulinum Toxin A Injection into the Urethral Sphincter and Further Bladder Management for Voiding Dysfunction among Patients with Spinal Cord Injury and Voiding Dysfunction

Purpose: This study aimed to investigate improvement in voiding condition after the initial botulinum toxin A (BoNT-A) injection into the urethral sphincter among patients with chronic spinal cord injury (SCI) and voiding dysfunction. Moreover, subsequent surgical procedures and bladder management were evaluated. Materials and Methods: From 2011 to 2020, 118 patients with SCI and dysuria who wanted to void spontaneously received their first BoNT-A injection at a dose of 100 U into the urethral sphincter. Improvement in voiding and bladder conditions after BoNT-A treatment were assessed. Next, patients were encouraged to continually receive BoNT-A injections into the urethral sphincter, convert to other bladder managements, or undergo surgery. After undergoing bladder management and surgical procedures, the patients were requested to report improvement in voiding condition and overall satisfaction to bladder conditions. Then, data were compared. Results: In total, 94 male and 24 female participants were included in this analysis. Among them, 51 presented with cervical, 43 with thoracic, and 24 with lumbosacral SCI. After BoNT-A injections into the urethral sphincter, 71 (60.2%) patients, including 18 (15.3%) with excellent, and 53 (44.9%) with moderate improvement, had significant improvement in voiding condition. Patients with cervical SCI (66.6%), detrusor overactivity and detrusor sphincter dyssynergia (72.0%), partial hand function (80.0%), and incomplete SCI (68.4%) had a better improvement rate than the other subgroups. Only 42 (35.6%) patients continually received treatment with BoNT-A injections into the urethral sphincter. Meanwhile, more than 60% of patients who converted their treatment to augmentation enterocystoplasty (n = 5), bladder outlet surgery (n = 25), BoNT-A injections into the detrusor muscle (n = 20), and medical treatment (n = 55) had moderate and marked improvement in voiding dysfunction and overall satisfaction. Discussion: Although BoNT-A injections into the urethral sphincter could improve voiding condition, only patients with SCI who presented with voiding dysfunction were commonly satisfied. Those whose treatments were converted to other bladder managements, which can promote urinary continence, or to surgical procedures, which can facilitate spontaneous voiding, had favorable treatment outcomes.     

玉竹多糖干预后衰老模型鼠抗氧化系统及免疫功能的变化

目的：观察具有扶正固本，养阴润燥和滋补强壮功效的百合科黄精属植物药玉竹的提取物玉竹多糖对D-半乳糖致亚急性衰老模型小鼠血清中超氧化物歧化酶活性和丙二醛含量的抗氧化系统作用及免疫功能的影响，探讨玉竹多糖抗衰老的可能作用途径。 方法：实验于2004-07／2005—05锦州医学院免疫教研室完成。①取昆明小鼠50只，随机分为5组：正常对照组、衰老模型组和低．中、高剂量玉竹多糖治疗组。除正常对照组外，其余各组每只颈背部皮下注射50g／L D-半乳糖0．5mL，连续6周。同时低、中．高剂量玉竹多糖治疗组分别腹腔注射0.5，1，2g／kg剂量的玉竹多糖（玉竹为百合科黄精属植物药，药用根茎，由锦州医学院免疫教研室采摘，经中国医科大学免疫教研室潘兴瑜教授乙醇回流脱脂、水提纯、浓缩、醇沉、除蛋白、离心、真空干燥等程序，得到玉竹多糖；玉竹产自锦州凌海市温滴楼乡岩井寺工区）溶液0．5mL，正常对照组和衰老模型组小鼠给予腹腔注射生理盐水0．5mL。②给药6周后，麻醉下将小鼠摘除眼球取血，常规分离血清，在4℃下3000r／min离心5min，取上清待测。用分光光度计检测小鼠血清中超氧化物歧化酶活性和丙二醛水平，并将小鼠称质量并剖取小鼠胸腺和脾脏，用电子天平称质量，以脏器湿质量（mg/g）表示小鼠脾指数和胸腺指数，用MTT法测定脾淋巴细胞转化指数，用免疫荧光法测定脾T淋巴细胞亚群，观察玉竹多糖对免疫功能的影响。③多组间样本均数比较采用方差分析。 结果：昆明种小鼠50只均进入结果分析。①衰老模型组小鼠血清中超氧化物歧化酶活性明显低于正常对照组，丙二醛水平明显高于正常对照组俨〈0．05）。高剂量玉竹多糖治疗组小鼠血清中超氧化物歧化酶活性明显高于衰老模型组，丙二醛水平明显低于衰老模型组（P〈0．01，0．05）；中、低剂量玉竹多糖治疗组与衰老模型组血清中超氧化物歧化酶活性和丙二醛水平比较，差异不明显（P〉0．05）。②衰老模型组小鼠胸腺指数和脾指数明显低于正常对照组（P〈0．01，0．05）；低、中、高剂量玉竹多糖治疗组的胸腺指数和脾指数均明显高于衰老模型组（P〈0．05-0．01），以中剂量玉竹多糖治疗组作用最明显（P〈0．01）；3个剂量玉竹多糖治疗组之间胸腺指数和脾指数差异不明显。⑧衰老模型组小鼠脾T和B淋巴细胞转化刺激指数均明显低于正常对照组（P〈0．05，0．01）；高剂量玉竹多糖治疗组小鼠脾T淋巴细胞转化刺激指数和各剂量玉竹多糖治疗组小鼠脾B淋巴细胞转化刺激指数明显高于衰老模型组（P〈0．05）。④各组小鼠脾脏中CD4^＋细胞数差异不明显（P〉0．05）；正常对照组和各剂量玉竹多糖治疗组小鼠脾脏中CD8^＋细胞数明显多于衰老模型组（P〈0．05-0．01），CD4^＋／CD8^＋比值则明显低于衰老模型组（P〈0．01）。 结论：①玉竹多糖可能通过提高衰老小鼠血清超氧化物歧化酶活性，增强对自由基的清除能力，抑制脂质过氧化，降低丙二醛含量，从而减轻衰老小鼠机体组织损伤程度，以延缓衰老。②玉竹多糖对亚急性衰老小鼠免疫器官的功能具有一定的调节作用，可改善机体的免疫失衡状态，从而增强机体的细胞及体液免疫功能，延缓衰老。     

胃黏膜相关性非霍奇金淋巴瘤的诊断和治疗

目的 总结胃黏膜相关性非霍奇金淋巴瘤的诊治经验.方法 回顾性分析27例经病理证实的胃黏膜相关性非霍奇金淋巴瘤的诊治情况.结果 临床表现以卜腹痛、消化管出血、消瘦多见.18例行X线钡餐检查,仪1例确诊;26例行胃镜检查,有24例被误诊为胃癌或胃溃疡.所有病例均经手术治疗,其中根治性切除25例,随访24例.结论 重视胃黏膜相关性非霍奇金淋巴瘤的临床表现及X线检查特点,胃镜检查时多部位深取材可提高本病的诊断率,免疫组化检查有助于确诊.手术切除应为首选治疗,术后加用化疗以巩固疗效.     

Aggressive Glucose Control for Acute Ischemic Stroke Patients by Insulin Infusion

Background and Purpose

Hyperglycemia after acute ischemic stroke (AIS) is associated with poor outcomes. However, there is no consensus as to the optimal method for glycemic control. We designed an insulin infusion protocol for aggressive glucose control and investigated its efficacy and safety.

Methods

We applied our protocol to patients within 48 hours after AIS or transient ischemic attack (TIA) with an initial capillary glucose level of between 100 and 399 mg/dL (5.6-22.2 mmol/L). An insulin solution comprising 40 or 50 U of human regular insulin in 500 mL of 5% dextrose was administered for 24 hours. Capillary glucose was measured every 2 hours and the infusion rate was adjusted according to a nomogram with a target range of 80-129 mg/dL (4.4-7.2 mmol/L). Changes in glucose and overall glucose levels during insulin infusion were analyzed according to the presence of diabetes or admission hyperglycemia (admission glucose >139 mg/dL or 7.7 mmol/L) by the generalized estimating equation method.

Results

The study cohort comprised 115 consecutive patients. Glucose was significantly lowered from 160±57 mg/dL (8.9±3.2 mmol/L) at admission to 93±28 mg/dL (5.2±1.6 mmol/L) during insulin infusion (p<0.05). Laboratory hypoglycemia (capillary glucose <80 mg/dL or 4.4 mmol/L) occurred in 91 (71%) patients, 11 (10%) of whom had symptomatic hypoglycemia. Although glucose levels were significantly lowered and maintained within the target range in all patients, overall glucose levels were significantly higher in patients with diabetes or hyperglycemia (p<0.05).

Conclusions

Our insulin-infusion protocol was effective in glycemic control for patients with AIS or TIA. Further modification is needed to improve the efficacy and safety of this procedure, and tailored intervention should be considered according to glycemic status.     

Hybrid palliation for right atrial isomerism associated with obstructive total anomalous pulmonary venous drainage

A twenty-four-day-old girl, who was prematurely born at 36 weeks of gestation, and weighed 2.2 kg, and diagnosed with right atrial isomerism, functionally single ventricle, bilateral superior vena cava (SVC) and obstructive supracardiac total anomalous pulmonary venous drainage (TAPVD) draining to the junction between the right SVC and the right atrium, underwent a hybrid procedure in the operating room, which consisted of pulmonary artery banding, ductus ligation and stenting of the draining vein of TAPVD. Obstruction at the drainage site of TAPVD was initially relieved after stenting, but, one month after the procedure, the distal end of the stent became stenotic and she received bilateral sutureless repair of TAPVD. At postoperative seven months, she underwent bidirectional cavopulmonary shunt uneventfully, and she has been followed-up for two months in a stable state without any problem in the pulmonary venous pathway.     

Conversion to low transfusion-related acute lung injury (TRALI)-risk plasma significantly reduces TRALI

BACKGROUND: Transfusion‐related acute lung injury (TRALI) is an uncommon but serious transfusion reaction. Studies have shown that the transfusion of HLA and HNA antibodies in donor plasma can lead to TRALI. Female donors are more likely to have such antibodies due to alloantigen exposure during pregnancy. Many blood suppliers have now implemented various TRALI risk reduction strategies to unknown effect. A retrospective analysis of TRALI reactions in plasma recipients before and after the conversion to low‐TRALI‐risk plasma (all‐male donor plasma, male‐predominant plasma, nulliparous female plasma, and HLA antibody–tested plasma) is reported. STUDY DESIGN AND METHODS: Transfusion reaction reports at three large hospitals 16 months before and 16 months after the conversion to low‐TRALI‐risk plasma were analyzed. Respiratory reactions were categorized as TRALI, possible TRALI, or other (e.g., transfusion‐associated circulatory overload or allergic reactions). Reactions were reported as a percentage of total units transfused and rates for the two time periods were compared. Trends in reaction rates for other components were also compared. RESULTS: A total of 2156 transfusion reactions in association with 461,598 transfused blood components were reviewed. The incidence of combined TRALI or possible TRALI reactions, due to the transfusion of plasma, decreased from 0.0084% to zero (p = 0.052). The rate of TRALI or possible TRALI reactions in red blood cell and platelet recipients did not change significantly. CONCLUSION: The conversion to low‐TRALI‐risk plasma has reduced the incidence of TRALI reactions in plasma recipients.     

Impact of paracrine signals from brain microvascular endothelial cells on microglial proliferation and migration

Neuronal survival can be influenced by activated microglia, but limited evidence exists on the effects of paracrine signaling from brain microvascular endothelial cells (BMECs) on microglial action. Therefore, we examined the effects of normal BMECs conditioned medium (BMECs-CM) on activated microglia induced by pro-inflammatory cytokine macrophage inflammatory protein-1beta (MIP-1β), a chemokine that released from ischemic BMECs and has been proved to stimulate microglial proliferation. Our results showed that BMECs-CM inhibited the proliferation and transmigration of microglia induced by MIP-1β. Moreover, BMECs-CM significantly suppressed the expression of the MIP-1β receptor, CCR5, and the phosphorylation of p38 and JNK (P<0.05). These findings suggest that BMECs-CM could inhibit MIP-1β-induced microglial activation. Future therapeutic strategies that prioritize the early recovery of BMECs could be beneficial for microglial inhibition and further increase neuronal survival.     

新复合杂合突变致婴儿型低磷酸酯酶症1例及其家系分析

该文对1例婴儿型低磷酸酯酶症(HPP)患儿及其家系进行临床特点分析及碱性磷酸酯酶基因(ALPL)检测。先证者,男,5个月,多发骨骼畸形:胸骨凹陷、双侧桡骨弯曲畸形、双膝外翻畸形,伴喂养困难、体重下降、发育迟滞、反复肺炎并呼衰,血碱性磷酸酶显著降低。患儿父母、姐姐、叔父、姨母(其他家系成员未能配合)中除父母及姨母的碱性磷酸酶略低,姨母可见脊柱侧弯畸形,余均无临床表型及实验室异常。患者ALPL基因检测到来源于母亲的c.228delG突变及来源于父亲的c.407GA复合杂合突变,其姨母携带c.228delG突变。c.407GA突变为已报道的HPP致病突变,c.228delG为新的致病性突变。低磷酸酯酶症是由ALPL基因突变所致,ALPL基因检测是有效的诊断方法。该研究拓展了ALPL基因突变谱,为HPP的基因诊断提供了理论依据。