Stress as a trigger of attacks in Menière's disease. A case-crossover study

BACKGROUND: Menière's disease is defined as the presence of recurrent, spontaneous episodic vertigo, hearing loss (HL), aural fullness, and tinnitus. The occurrence of attacks is unpredictable. The etiology is still unknown, but the disease has a pathologic correlate in hydropic distension of the endolymphatic system. Earlier studies have shown increased incidence of stress on the same day as vertigo attacks, but it has not been determined whether stress occurring on the day of the vertiginous episode came before or after the onset of the vertigo. METHODS: A case-crossover study including 46 patients with active Menière's disease. MAIN OUTCOME MEASURE: Relative risks with 95% confidence intervals (CI). FINDINGS: During the study period, 153 Menière's attacks were reported. Twenty-four (52%) of the 46 patients reported attacks. Twelve of the 153 (8%) attacks occurred within 3 hours after exposure to emotional stress. The relative risk of having an attack was 5.10 (95% CI 2.37-10.98) during 3 hours after being exposed to emotional stress. Twenty-nine percent of the patients with attacks had at least one attack after exposure to emotional stress. For mental stress, the relative risk was 4.16 (95% CI 1.46-11.83) and the hazard period 1 hour, but only five attacks were exposed. No excess risk was found after physical stress. INTERPRETATION: Being exposed to emotional stress increases the risk of getting an attack of Menière's disease during the next hour, and the hazard period is possibly extended up to 3 hours.     

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??Clinical study of insulin resistance for patients after selective abdominal surgery CHEN Hong*, LI Fei , JIA Jian-guo, et al. *Department of General Surgery, Xuan Wu Hospital of Capital Medical University, Beijing 100053, China Corresponding author: CHEN Hong, E-mail: chenhong@medmail.com.cn Abstract Objective To investigate the risk factors of insulin resistance(IR) after selective abdominal surgery and the mechanism of IR induced by surgery. Methods Fourteen-patients including five male and nine female after selective abdominal surgery between March 2006 and June 2006 at Xuan Wu Hospital of Capital Medical University were studied. Fasting blood glucose, fasting plasma insulin, plasma TNF-α and IL-6 were tested for selective surgery patients on one day before, during and one day after surgery. Insulin resistance index (HOMA-IR) and the index of insulin secretion (HOMA-β) were calculated with homeostasis model assessment (HOMA). Insulin receptor and GLUT4 mRNA expression in skeletal muscle were assessed before and at the end of operation. Results Significant differences were found in fasting blood glucose, fasting plasma insulin, plasma TNF-α and IL-6 of pre-operative 1 day, during operation and post-operative 1 day (P <0.001). A significant elevation of HOMA-IR level was found on post-operative 1 day compared to that before surgery in all patients (P <0.001). However there was no significant difference in HOMA-β among the same two points of time (P=0.103). The result of RT-PCR showed that the expression of GLUT4 mRNA in muscle of patients at the end of operation reduced significantly compared with preoperation (P<0.001). ISI showed negative correlation with operative time(r=-0.736,P <0.001), blooding during operating (r=-0.594,P=0.032) and post-operative TNF-α(r=-0.641,P =0.018). R2 of the equation was 0.687. Conclusion Insulin resistance occurs in selective abdominal surgery patients. The defective site was at postreceptor, and the decrease of content and action of GLUT4 may play an important role in its mechanism. To control the intensity of surgery is helpful for decreasing IR.     

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??Intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors HU Ji-xiong??DAI Wei-dong??MIAO Xiong-ying??et al. Department of Hepatobiliary Surgery, the Second Xiangya Hospital of Central South University, Changsha 410011, China Corresponding author??DAI Wei-dong??E-mail:daiweidong@medmail.com.cn Abstract Objective To evalualte intrahepatic Glissonian approach for mesohepatectomy in the management of primary hepatic tumors. Methods The clinical data of 24 cirrhotic patients with primary liver tumor admitted from May 2005 to December 2007 at the Second Xiangya Hospital of Central South University were analyzed retrospectively. Results Mesohepatectomy was feasible with the proposed technique in all patients. No patients experienced massive bleeding during the operation. The estimated intraoperative mean amount of blood loss was 300mL (range 200 to 1200mL). The mean operating time was ??258±60?? minutes and only 2 patients required blood transfusion for 2U. Minor postoperative complications included bile leakage in 3 cases, subphrenic infection in 2 cases and resolved with conservative management. No hospital mortality occurred. Conclusion Intrahepatic Glissonian access for mesohepatectomy in cirrhotic patients is safe and effective. It may reduce intraoperative blood loss and the need for the pringle maneuver.     

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??Diagnosis and treatment of hyperparathyroid crisis??a report of 4 cases BAI Yan-xia*, MA Qing-yong, YAN Li-ying, et al . *Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital, Medical College of Xi’an Jiaotong University??Xi’an 710061??China Corresponding Author?? MA Qing-yong, E-mail: qyma56@xjtu.edu.cn Abstract Objective To explore the diagnostic and therapeutic method of hyperparathyroid crisis. Methods The clinical data, the operative technique, the therapeutic effect of 4 cases which were treated in First Affiliated Hospital of Xi’an Jiaotong University from January 2005 to May 2007 were presented. Through reviewing pertinent literature, we discuss the qualitative diagnosis??level diagnosis and operative juncture of primary hyperparathyroidism complicating hyperparathyroid crisis. Results The three patients were healed by promptly exploratory parathyroidectomy and medical treatment. One patient died for complicating of multiple organ dysfunction. Conclusions Promptly exploratory parathyroidectomy after temporal medical treatment is an effective method to rescue the patient of primary hyperparathyroidism complicating hyperparathyroid crisis??The exploratory parathyroidectomy can be successed on preoperative definite diagnosis and accurate localization??frozen section and quickly PTH determination in the operation.     

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??Effect of laparoscopic surgery CO2 pneumoperitoneum for colorectal cancer on femoral venous hemodynamics WANG Yu*??WANG Yan-ting??JIANG Yan-yan??et al.*Department of General Surgery??Fuzhou General Hospital of Nanjing Military Command??Fuzhou 350025??China Corresponding author:ZOU Zhong-dong,E-mail: fzptwk@21cn.com Abstract Objective To study the effect of the special surgical position and CO2 pneumoperitoneum on femoral venous hemodynamics during laparoscopic surgery for colorectal cancer.Methods Color Doppler ultrasound was adopted to evaluate the diameter??blood velocity and volum of the blood flow in the lower extremity with 30 patients undergoing laparoscopic surgery for colorectal cancer in Fuzhou General Hospital of Nanjing Military Command between August 2007 to June 2008,with different pressure of pneumoperitoneum??6mmHg??8mmHg??10mmHg??12mmHg??and that during the laparoscopic surgery for colorectal cancer with 12mmHgCO2 pneumoperitoneum and head-down tilt position. Results Compared with the stage before the pneumoperitoneum, no change was obserbed with the hemodynamics indexes after the establishment of 6mmHgCO2 pneumoperitoneum??when the pressure of pneumoperitoneum increases to 8mmHg, the femoral vein diameter increases?? the velocity and the amount of blood flow decrease by degrees (P<0.05) with the accrescence of pneumoperitoneum pressure. During the operation, the femoral vein diameter decreased??the velocity and the volum of blood flow increased with the head-down tilt position,but still less than the level before pneumoperitoneum, compared with the stage of prostration after pneumoperitoneum,;At the end of operation without the exhaust of CO2 gas,the femoral vein diameter returned to the level of the prostration after pneumoperitoneum, while the velocity and the volum of blood flow was still higher than that, but significantly lower than that of feet-down tilt position with pneumoperitoneum; At the end of operation with prostration and the exhaust of CO2 gas , the femoral vein diameter decreased,but still thicker than prostration without pneumoperitoneum,and the velocity and the volum of blood flow returned to the level before pneumoperitoneum. Conclusion The CO2 pneumoperitoneum can interfere the recirculation of blood??positive correlated to the pressure,witch will increase the risk of venous thrombosis ,so we should take the lower-grade of pneumoperitoneum pressure as far as possible . Besides, the head-down tilt position is conducive for the blood to recirculate ,which can improve but not fully offset the poor blood returning conducted by CO2 pneumoperitoneum .The vein stasis exists objectively in the perioperation of laparoscopic colorectal cancer operation, which will increase the risk of venous thrombosis ,and taking the active preventive measures is requisite.     

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??Clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type--A prospective multi-centric study YIN Da-long*, LU Zhao-yang, LIU Lian-xin, et al. *The First Affiliated Hospital,Haerbin Medical University ,Haerbin 150001,China Corresponding author: LIU Lian-xin,E-mail:liulianxin@medmail.com.cn Abstract Objective To investigate the clinical efficacy and safety of moxifloxacin for acute cholangitis of severe type(ACST). Methods In this prospective, single-blind, multi-centric study a total of 50 consecutive patients from January 2008 to June 2008 with ACST were included the current clinical trial. The efficacy and safety of moxifloxacin 400 mg by intravenous infusion once daily were evaluated to treat ACST accompanying surgery or endoscopy. The clinical and bacteriologic response at different intervals after administration were observed, as well as body temperature, leucocytes, alanine aminotransferase, total bilirubin, alkaline phosphate andγ-glutamyltransferase. Results The temperature and leucocytes of 42 in 49 patients were markedly decreased at 3 days after treatment compared to those at admission . There were significant decrease (P<0.01) in alanine aminotransferase, total bilirubin, alkaline phosphate and γ-glutamyltransferase at 3 days comparable with those at admission, respectively. Clinical success rates at test-of-cure were 85.7% (42 of 49) for moxifloxacin. Pathogens were isolated from bile or blood cultures in all patients. Thirty out of 49 patients had positive bile and/or blood cultures, including 11(36.7%) patients with mixed infection with several species. The predominant strains were E.coli (22/49), Klebsiella species (8/49) and Enterococcus species (5/49). Bacterial eradication rates were 83.3%(35/42) for moxifloxacin at 7 days after administration.Conclusion E.coli, Klebsiella species and Enterococcus species were the most common bacteria isolated from bile or blood from patients with ACST and a mixed infection with several species was observed. Moxifloxacin evidently showed high clinical and bacteriological efficacies and safety in the hospitalized patients with ACST.     

Alterations in the epidermal-dermal melanin axis and factor XIIIa melanophages in senile lentigo and ageing skin

Background Senile lentigo (SL) is a pigmentation disorder that occurs predominantly on the dorsa of the hands, the forearms and the face; its incidence increases with age. Histological hallmarks of SL lesions are hyperpigmentation of the epidermis and elongation of the epidermal rete ridges. Various factors such as α‐melanocyte‐stimulating hormone, endothelin‐1 or stem cell factor are involved in the onset and maintenance of the increased pigmentation. Alterations of the dermal compartment have not yet been analysed in detail in SL. Objectives To study the occurrence and distribution of melanin in the dermis from SL and aged skin, biopsies from 12 subjects were morphologically analysed by light and electron microscopy in comparison with unaffected skin. Methods Punch biopsies of SL and adjacent skin from 12 male or female volunteers aged 52–81 years were prepared for light and electron microscopy and samples were analysed by morphological, morphometric, histochemical and immunohistochemical methods. Results The epidermis from SL revealed morphological features such as hyperpigmentation of basal keratinocytes and the formation of elongated rete ridges. S100+ melanocytes in the stratum basale were not markedly increased, indicating that the hyperpigmentation is predominantly due to changes in melanin synthesis, distribution or turnover. Quantification of epidermal cells expressing the proliferation marker Ki67 did not show an increase of this parameter in SL, indicating that at least in the established lesion cell proliferation is not enhanced. We further focused on the dermal compartment and observed granulated cells which were more abundant in SL. Electron microscopic and histochemical analysis revealed that the granulation of these cells is based on melanosomes, mostly present in large melanosomal complexes. Immunohistochemistry using antibodies to CD68 and factor XIIIa (FXIIIa) showed these melanophages to be predominantly FXIIIa+ dermal dendrocytes, which were about six times more abundant than CD68+ macrophages. Conclusions In SL an increased number of melanophages was found compared with unaffected skin from the same subject. These melanophages were identified as FXIIIa+ dermal dendrocytes. Possible functional consequences of the massive melanin uptake by dermal dendrocytes are discussed.     

丙泊酚靶控输注用于儿童鼾症鼻内镜手术

目的评价丙泊酚靶控输注在儿童鼻内镜手术中对血压、心率、术野出血及术后苏醒过程的影响。方法86例因腺样体肥大拟行手术患儿,ASA为Ⅰ-Ⅱ级,随机分成二组,每组43例,B组行丙泊酚靶控输注麻醉,I组行异氟醚吸入麻醉。分别观察手术开始后10,25,45 m in血压、心率变化及术野质量评分,记录术毕患儿自主呼吸恢复时间、睁眼时间、拔管时间,观察术后恶心、呕吐、躁动的发生率。结果①两组收缩压、舒张压和术野质量评分无显著差异;②B组患儿术后自主呼吸恢复时间、睁眼时间、拔管时间显著短于I组;③I组并发症高于B组。结论丙泊酚靶控输注用于儿童鼻内镜手术,血压、心率、术野质量评分佳,术毕麻醉恢复更为迅速、优良。     

Role of taurine accumulation in keratinocyte hydration

Epidermal keratinocytes are exposed to a low water concentration at the stratum corneum-stratum granulosum interface. When epithelial tissues are osmotically perturbed, cellular protection and cell volume regulation is mediated by accumulation of organic osmolytes such as taurine. Previous studies reported the presence of taurine in the epidermis of several animal species. Therefore, we analyzed human skin for the presence of the taurine transporter (TAUT) and studied the accumulation of taurine as one potential mechanism protecting epidermal keratinocytes from dehydration. According to our results, TAUT is expressed as a 69 kDa protein in human epidermis but not in the dermis. For the epidermis a gradient was evident with maximal levels of TAUT in the outermost granular keratinocyte layer and lower levels in the stratum spinosum. No TAUT was found in the basal layer or in the stratum corneum. Keratinocyte accumulation of taurine was induced by experimental induction of skin dryness via application of silica gel to human skin. Cultured human keratinocytes accumulated taurine in a concentration- and osmolarity-dependent manner. TAUT mRNA levels were increased after exposure of human keratinocytes to hyperosmotic culture medium, indicating osmosensitive TAUT mRNA expression as part of the adaptation of keratinocytes to hyperosmotic stress. Keratinocyte uptake of taurine was inhibited by beta-alanine but not by other osmolytes such as betaine, inositol, or sorbitol. Accumulation of taurine protected cultured human keratinocytes from both osmotically induced and ultraviolet-induced apoptosis. Our data indicate that taurine is an important epidermal osmolyte required to maintain keratinocyte hydration in a dry environment.