经颅磁刺激运动诱发电位在腰椎管狭窄症临床评价中的应用价值

目的 分析经颅磁刺激运动诱发电位(motor evoked potentials,MEP)在腰椎管狭窄症临床评价中的应用价值.方法 23例腰椎管狭窄患者,男12例,女11例;年龄52～83岁,平均67.9岁.单纯腰椎管狭窄症11例,合并腰椎退变性滑脱12例.就诊时平均病程31.5个月(3个月～10年).出现单侧下肢症状者(疼痛或麻木、无力)9例,双下肢均出现者14例.所有患者均合并间歇性跛行,出现跛行前平均行走距离为302.1 m(3～1000 m).MRI中最狭窄节段的硬膜囊向积值(minimum cross-sectional area, MCSA)平均0.4 cm2(0.1～0.9 cm2).于患者双侧(足母)内收肌处记录经颅磁刺激MEP潜伏期(MEP latency,MEPLT),同时收集患者治疗前JOA评分、视觉模拟评分(VAS,包括腰痛,下肢、臀部痛及麻木程度).采用SPSS 12.0软件进行统计学分析.结果 MEPLT为(42.1±2.8)ms,JOA评分为(15.9±4.8)分.腰痛、下肢及臀部痛、下肢及臀部麻木感VAS分别为(6.0±2.9)分、(7.7±1.9)分、(7.3±3.0)分.MEPLT与步行距离、下肢症状类型及麻木VAS存在相关.步行距离＜500 m者MEPLT明显延长(t=3.529,P＜0.05).结论 MEPLT延长在腰椎管狭窄患者出现临床体征之前即可出现,MEP可有效反映患者的主观症状.     

Treatment of pancreatic fistula after pancreatoduodenectomy using a hand-made T-tube

Background/Purpose  

To describe a technique for the treatment of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) using a hand-made T-tube.     

动物检疫实验室标准化管理

作者简要叙述了建立的标准化动物检疫实验室的重要性,并从实验室人员素质建设、仪器设备管理、质量控制、文件体系以及信息管理等方面出发,要求建立健全标准化动物检疫实验室质量管理体系,为动物检疫提供准确而有效的依据。     

Less-Frequent Fusarium Species of Clinical Interest: Correlation between Morphological and Molecular Identification and Antifungal Susceptibility

Forty-eight Fusarium isolates morphologically identified as belonging to seven species of clinical interest (i.e., Fusarium chlamydosporum, Fusarium dimerum, Fusarium incarnatum, Fusarium napiforme, Fusarium nygamai, Fusarium proliferatum, and Fusarium sacchari) were characterized molecularly by the analysis of the sequences of the TUB region of the β-tubulin gene. F. chlamydosporum and F. dimerum were the most genetically heterogeneous species. A high degree of correlation between the morphological and molecular identification was shown among the isolates studied. A table with the key morphological features for the identification of these Fusarium species is provided. The antifungal susceptibilities of the Fusarium isolates to 11 antifungal drugs were tested; terbinafine was the most active drug against all the species tested with the exception of F. incarnatum, for which amphotericin B was the most active.The most frequent species causing fusariosis are Fusarium solani, Fusarium oxysporum, and Fusarium verticillioides (1, 16, 47), but several other species are also found to cause human infections, although less frequently. Some of these species are Fusarium chlamydosporum, Fusarium dimerum, Fusarium incarnatum, and the following other species that are included into the Gibberella fujikuroi species complex: Fusarium napiforme, Fusarium nygamai, Fusarium proliferatum, and Fusarium sacchari (30, 31). These species have been associated with different types of infection, in particular with keratomycoses and other ocular infections (10) and with disseminated infections in immunocompromised patients (2, 6, 17, 20, 23, 24, 26, 39, 41, 43, 44). The real incidence of these species is unknown since they are poorly known and laboratorians and clinical microbiologists are not generally aware of their possible presence in human infections.Since the species of Fusarium are generally resistant to all the available antifungal drugs (40), it could be considered that speciation of Fusarium is necessary only for epidemiological purposes. However, some in vitro data concerning particular species seem to be very promising and deserve to be investigated clinically. For instance, F. verticillioides isolates were susceptible to posaconazole and terbinafine and Fusarium thapsinum isolates to terbinafine (4). The identification of fusaria to the species level is not easy, and in numerous clinical cases the etiological agent is reported as being a Fusarium sp. However, several recent studies have demonstrated the usefulness of molecular methods for the identification of those Fusarium species that are difficult to distinguish morphologically (1, 4, 47). In recent years, the in vitro antifungal susceptibilities of the most frequent species of Fusarium have been evaluated (1, 3, 4, 40, 47), but only a few isolates of the less-common species have been studied. The objectives of our study were (i) to evaluate the correlation between the morphological and the molecular identification of less-frequent Fusarium species isolates received by our laboratory and (ii) to determine the antifungal susceptibilities of isolates representative of those less-common Fusarium species of clinical interest identified molecularly.     

Maternal isobutyl-paraben exposure alters anxiety and passive avoidance test performance in adult male rats

Isobutyl-paraben (IBP), one of the most widely used preservatives, exhibits estrogenic activity. In this study, we analyzed the effects of maternal IBP treatment on the emotional behavior and learning performance in mature offspring. Pregnant female Sprague–Dawley rats were treated with IBP via a subcutaneous Silastic capsule. Consequently, the offspring were exposed to IBP during gestation through the placentae, and before weaning through the milk. Male and female offspring were tested for emotional behavior in an open field and in an elevated plus maze at five and six weeks old, respectively. IBP-exposed male (but not female) rats spent less time in the open arms of the elevated plus maze. At 11 weeks old, all females were gonadectomized and treated chronically with 17β-estradiol or cholesterol by Silastic capsules; all males were kept intact. They were tested for learning performance in a passive avoidance test and a Morris water maze. IBP exposure impaired the performance of males in the passive avoidance test. These findings suggest that male rats are more affected by early exposure to IBP than female rats. IBP affects their adult behavior including anxiety and learning abilities.     

Human pelvic extramural ganglion cells: a semiquantitative and immunohistochemical study

In pelvic surgery, much attention is paid to nerve bundles but not to ganglion cells. Using serial section histology of 14 postmortem-treated hemipelvis (eight males, six females; mean, 79 years old), we examined the population number, distribution, and tyrosine hydroxylase-immunoreactivity (TH-IR; suggesting sympathetic neurons) of extramural pelvic ganglion cells. All pelvic ganglion cells were uniformly sized (25–30 μm) contrasting with small intramural rectal neurons. Abundant ganglion cells (30,000–140,000 unilaterally) existed not only along the pelvic viscera except for the rectum, but also along the hypogastric nerve, pelvic splanchnic nerve, pelvic plexus, and associated branches excluding those within the mesorectum. The intrapelvic ganglion cells outside the sympathetic trunk did not form macroscopically identifiable ganglia, but made small clusters (0.1–2.0 mm of maximum diameter) or were diffusely scattered within nerve bundles. More than half of these cells appeared TH-IR positive, although the positive/negative proportion differed between nerves and specimens. Greater numbers of ganglion cells were found in dorsosuperior sites (e.g., around the seminal vesicle) rather than in ventroinferior sites (e.g., along the urethra) in males, and vice versa in females. However, in total cell numbers, interindividual variations were evident rather than intergender difference. Due to significant interindividual variations in cell number, differences are likely to exist between patients in “resistance” to surgical stresses. We hypothesized that pelvic ganglion cells are liable to be damaged due to drying along the surgical margin, hypoxia in venous bleeding, pressure from surgical retractors, extension stress with taping and excess traction and/or direct injury with electrical scalpels.     

Identification of novel RMRP mutations and specific founder haplotypes in Japanese patients with cartilage-hair hypoplasia

Cartilage-hair hypoplasia (CHH), or metaphyseal dysplasia, McKusick type, is an autosomal recessive disease with diverse clinical manifestations. CHH is caused by mutations in RMRP (ribonuclease mitochondrial RNA processing), the gene encoding the RNA component of the ribonucleoprotein complex RNase MRP. A common founder mutation, 70A>G has been reported in the Finnish and Amish populations. We screened 11 Japanese patients with CHH for RMRP mutations and identified mutations in five probands, including three novel mutations (16-bp dup at +1, 168G>A, and 217C>T). All patients were compound heterozygotes for an insertion or duplication in the promoter or 5′-transcribed regions and a point mutation in the transcribed region. Two recurrent mutations were unique to the Japanese population: a 17-bp duplication at +3 and 218A>G. Haplotype analysis revealed that the two mutations common in Japanese individuals were contained within distinct haplotypes. Through this analysis, we have identified a unique mutation spectrum and founder mutations in the Japanese population.Yuichiro Hirose and Eiji Nakashima contributed equally to this work.