重视神经康复的教学问题

随着老年人口比例的不断增大,脑血管病的发病率很难下降,卒中的一个显著特点是致残率高,继发障碍如肌萎缩、关节挛缩、足下垂、足内翻、肩关节半脱位等的根本原因是患肢的长期制动,幸存者不同程度地丧失劳动能力,早期康复训练可以大大降低其程度.而有些神经系统疾病,如遗传性疾病,甚至完全依赖于神经康复的治疗和护理.为提高患者的生活质量,康复治疗的重要性已为越来越多的人所认识.     

视黄酸影响斑马鱼胚胎心脏房室分化

目的观察外源性视黄酸对斑马鱼心脏前后轴发育即心脏房室分化的影响。方法采用化学遗传学方法在斑马鱼胚胎发育至12.5hpf(hours post fertilization)给予5×10-8mol/L和10-7mol/L外源性视黄酸处理1.5h。应用胚胎整体原位杂交观察视黄酸对心脏特异基因vmhc,amhc,nkx2.5和nppa表达的影响。结果vmhc,amhc探针的整体原位杂交结果显示视黄酸处理会导致斑马鱼胚胎心脏的前后轴发育异常,表现为vmhc表达细胞的范围缩小,amhc表达细胞的范围明显增大。视黄酸可以明显增强nppa在心脏的表达。视黄酸对心脏房室分化的影响在48hpf后表现得明显。结论5×10-8mol/L和10-7mol/L视黄酸在12.5hpf处理斑马鱼胚胎对斑马鱼心脏早期发生没有影响。斑马鱼发育过程中,视黄酸对心脏的房室分化过程起着重要的调控作用,视黄酸支持心房的分化和发育,同时抑制心室发育。     

五味沙棘散对卵清蛋白诱导的过敏性支气管哮喘大鼠的保护作用及机制

目的 探究五味沙棘散对卵清蛋白（ovalbumin,OVA）诱导的过敏性哮喘大鼠的保护作用及机制。方法 SD大鼠随机分为对照组、模型组、地塞米松（0.5 mg/kg）组和五味沙棘散（0.5、2.0 g/kg）组,建立OVA诱导的大鼠早期支气管哮喘模型,苏木素-伊红（HE）和Masson染色观察支气管病理情况及纤维化程度;免疫组化检测支气管间隙连接蛋白43（connexin 43,Cx43）的表达和分布;ELISA检测血清中免疫球蛋白E（immunoglobulin E,IgE）和白细胞介素-13（interleukin-13,IL-13）水平;亚甲基蓝法和WSP-1荧光探针法测定血清中硫化氢（hydrogen sulfide,H₂S）水平。建立CdCl₂诱导的支气管上皮BEAS-2B细胞损伤模型,MTT法检测细胞活性;Hoechest 33342染色法观察细胞核形态变化;MitoSOX染色检测细胞线粒体活性氧（mitochondrial reactive oxygen species,mtROS）水平;Western blotting检测半胱氨酸天冬氨酸蛋白酶-3（cystein-asparate protease-3,Caspase-3）、核因子红细胞系2相关因子（nuclear factor erythroid 2-related factor,Nrf2）和Kelch样ECH关联蛋白1（Kelch like ECH associated protein 1,Keap1）蛋白表达。结果 五味沙棘散能够减少支气管黏膜上皮细胞脱落和黏液分泌（P＜0.001）,降低胶原纤维的沉积和Cx43的表达及分布（P＜0.05、0.01、0.001）,降低血清中IgE、IL-13水平（P＜0.05）,升高血清中H₂S水平（P＜0.05、0.01）。五味沙棘散含药血清呈剂量相关性地抑制CdCl₂诱导的BEAS-2B细胞凋亡及mtROS水平（P＜0.01、0.001）,上调Caspase-3和Nrf2蛋白表达（P＜0.05、0.01）,下调Keap1蛋白表达（P＜0.01）。结论 五味沙棘散对OVA诱导的哮喘大鼠和CdCl₂诱导的支气管上皮细胞凋亡均具有保护作用,其机制可能与调控Nrf2/Keap1信号通路有关。     

Vertical split fracture of the vertebral body following oblique lumbar interbody fusion: A case report

Rationale:Oblique lumbar interbody fusion (OLIF) is an effective and safe surgical technique widely used for treating spondylolisthesis; however, its use is controversial because of several associated complications, including endplate injury. We report a rare vertebral body fracture following OLIF in a patient with poor bone quality.Patient concerns:A 72-year-old male patient visited our clinic for 2 years with lower back pain, leg radiating pain, and intermittent neurogenic claudication.Diagnoses:Lumbar magnetic resonance imaging revealed L4-5 stenosis.Intervention:We performed OLIF with percutaneous pedicle screw fixation and L4 subtotal decompressive laminectomy. We resected the anterior longitudinal ligament partially for anterior column release and inserted a huge cage to maximize segmental lordosis. No complications during and after the operation were observed. Further, the radiating pain and back pain improved, and the patient was discharged. Two weeks after the operation, the patient visited the outpatient department complaining of sudden recurred pain, which occurred while going to the bathroom. Radiography and computed tomography revealed a split fracture of the L5 body and an anterior cage displacement. In revision of OLIF, we removed the dislocated cage and filled the bone cement between the anterior longitudinal ligament and empty disc space. Further, we performed posterior lumbar interbody fusion L4-5, and the screw was extended to S1.Outcomes:After the second surgery, back pain and radiating pain in the left leg improved, and he was discharged without complications.Lesson:In this case, owing to insufficient intervertebral space during L4-5 OLIF, a huge cage was used to achieve sufficient segmental lordosis after anterior column release, but a vertebral body coronal fracture occurred. In patients with poor bone quality and less flexibility, a huge cage and over-distraction could cause a vertebral fracture; hence, selecting an appropriate cage or considering a posterior approach is recommended.     

Extracellular ATP promotes angiogenesis and adhesion of TNBC cells to endothelial cells via upregulation of CTGF

Our previous works have indicated that extracellular ATP is an important prometastasis factor. However, the molecular mechanism involved needs to be further studied. We demonstrated that extracellular ATP treatment could upregulate the expression of connective tissue growth factor (CTGF) in both triple‐negative breast cancer (TNBC) cells and endothelial cells (ECs). Extracellular ATP stimulated the migration of TNBC cells and ECs, and angiogenesis of ECs via the P2Y2––YAP‐CTGF axis. Furthermore, we demonstrated that adenosine triphosphate (ATP) stimulated TNBC cell adhesion to ECs and transmigration through the EC layer via CTGF by upregulation of integrin β1 on TNBC cells and VCAM‐1 on ECs. Both apyrase (ATP‐diphosphohydrolase) and CTGF shRNA treatments could inhibit the metastasis of inoculated tumors to lung and liver in a mouse model, and these treated tumors had fewer blood vessels. Collectively, our data indicated that extracellular ATP promotes tumor angiogenesis and the interactions between TNBC cells and ECs through upregulation of CTGF, thereby stimulating TNBC metastasis. The pleiotropic effects of ATP in angiogenesis and cell adhesion suggest that extracellular ATP or CTGF could be an effective target for TNBC therapy.     

Neoadjuvant chemotherapy endows CD9 with prognostic value that differs between tumor and stromal areas in patients with pancreatic cancer

BackgroundThe selective pressure imposed by chemotherapy creates a barrier to tumor eradication and an opportunity for metastasis and recurrence. As a newly discovered stemness marker of pancreatic ductal adenocarcinoma (PDAC), the impact of CD9 on tumor progression and patient''s prognosis remain controversial.MethodsA total of 179 and 211 PDAC patients who underwent surgical resection with or without neoadjuvant chemotherapy, respectively, were recruited for immunohistochemical analyses of CD9 expression in both tumor and stromal areas prior to statistical analyses to determine the prognostic impact and predictive accuracy of CD9.ResultsThe relationship between CD9 and prognostic indicators was not significant in the non‐neoadjuvant group. Nevertheless, CD9 expression in both tumor (T‐CD9) and stromal areas (S‐CD9) was significantly correlated with the clinicopathological features in the neoadjuvant group. High levels of T‐CD9 were significantly associated with worse OS (p = 0.005) and RFS (p = 0.007), while positive S‐CD9 showed the opposite results (OS: p = 0.024; RFS: p = 0.008). Cox regression analyses identified CD9 in both areas as an independent prognostic factor. The T&S‐CD9 risk‐level system was used to stratify patients with different survival levels. The combination of T&S‐CD9 risk level and TNM stage were accurate predictors of OS (C‐index: 0.676; AIC: 512.51) and RFS (C‐index: 0.680; AIC: 519.53). The calibration curve of the nomogram composed of the combined parameters showed excellent predictive consistency for 1‐year RFS. These results were verified using a validation cohort.ConclusionNeoadjuvant chemotherapy endows CD9 with a significant prognostic value that differs between tumor and stromal areas in patients with pancreatic cancer.     

Unusual morphologic features of low‐grade endometrial stromal sarcoma: A case report

BackgroundEndometrial stromal tumours are uncommon tumours of the uterus. They mainly occur in perimenopausal women. Tumours with typical clinicopathological features do not usually pose diagnostic problems. However, rare clinicopathological features can occur, and clinicians without significant experience may have difficulty diagnosing these tumours and managing these patients.MethodsHerein, we report a case of endometrial stromal sarcoma that occurred in a 25‐year‐old woman. The pathological features, immunophenotype, treatment and prognosis were discussed.ResultsThe tumour revealed morphological heterogeneity, and there were similar proliferative‐type endometrial stromal cells, an extensive amount of mature adipose tissue, and prominent rhabdomyoblastic and smooth muscle cells. Histopathological and immunohistochemical studies confirmed low‐grade endometrial stromal sarcoma with smooth muscle, adipocytic and rhabdomyoblastic differentiation (approximately 60% were differentiated tissues). The final treatment of the tumour was total abdominal hysterectomy with bilateral salpingo‐oophorectomy. There was no evidence of recurrence for 109 months postoperatively.ConclusionsWe found that low‐grade endometrial stromal tumours with extensive adipocytic and prominent rhabdomyoblastic differentiation are misdiagnosed because they are infrequent. They must be differentiated from rhabdomyosarcoma with accurate identification of adipocytes, and long‐term follow‐up is needed.