外周苯二氮卓受体示踪剂18F—SAN的合成

目的:根据先导化合物外周苯二氮卓受体激动剂N - (2,5 - 二甲氧苄基) - N - (5 - 氟 - 2 - 苯氧苯基)丙酰胺,合成18F标记的N - (2,5 - 二甲氧苄基) - 3 - 氟 - N - (5 - 氟 - 2 - 苯氧苯基)丙酰胺(18F - SAN)化合物.方法:18F离子与前体3 - 溴 - N - (2,5 - 二甲氧苄基) - N - (5 - 氟 - 2 - 苯氧苯基)丙酰胺进行亲核取代反应,标记产物采用半制备HPLC进行分离纯化.结果:初步结果显示,18F - SAN的放化纯度大于95%,放化产率为50%左右,全部合成时间约为60 min.TLC检测 18F - SAN的Rf值为0.4～0.5.HPLC检测18F - SAN的tR值为6.24 min.     

61例腹腔镜胃手术的经验总结

总结61例腹腔镜胃手术的治疗效果。方法:1992年12月至1999年1月,61例腹腔镜胃手术者中,B-Ⅱ式胃大部切除术17例,B-Ⅰ式胃大部切除术1例,近端胃次全切除术2例,高选择性迷走神经切断术5例,胃造瘘术3例,胃壁良性肿瘤切除术33例。54例行全腹腔镜下胃手术,7例行腹腔镜辅助下胃手术。结果:本组有2例早期胃癌行腹腔镜根治术,至今存活4.6年以上;并发症2例,分别通过再手术和内镜治愈;手术用时35～310min,平均164.2min;术中出血50～500ml,平均218.3ml;住院4～11d,平均6.8d;86％病人于术后48h内恢复胃肠功能;仅4例术后使用止痛剂。结论:只要合理使用、严格掌握手术适应证,腹腔镜胃手术可以取得良好效果。     

Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for patients with complex tracheobronchial stenosis: initial clinical experience

PURPOSE

We aimed to report our preliminary results of subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for patients with complex lower tracheal-carinal-main bronchial complex stenosis.

MATERIALS AND METHODS

Seven consecutive patients with lower tracheal-carinal-main bronchial complex stenosis underwent Y-shaped stent insertion under local anesthesia. During the procedure, subcarinal ventilation was performed using a 4 F angiographic catheter, and stent insertion was performed under the protection of ventilation. Data on technical success, clinical outcome, and follow-up were collected and analyzed.

RESULTS

Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia was technically successful in all patients without any major procedure-related complications. Seven stents were inserted in seven patients. Respiratory function improved in all patients, with the Hugh-Jones classification of respiratory status improving from grade IV–V before stenting to grade I–II after stenting. During the follow-up, one patient experienced re-stenosis of the stent. Average survival time was 185.7 days (range, 96–285 days) after the stenting procedure.

CONCLUSION

Subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia can be an effective, simple, and safe method for lower tracheal-carinal-main bronchial complex stenosis.Airway stenosis is usually caused by local primary lung cancer, esophageal cancer, or some other mediastinal tumors. Airway stent insertion is an effective and widely used method to manage this condition (1, 2). However, as the stent introducer sheath or bronchoscopy can aggravate hypoxia, asphyxia is the most serious procedure-related complication during airway stenting or interventional bronchoscopy. The incidence of asphyxia was reported in 1.5%–14.3% of cases undergoing airway stent insertion (2–4).To overcome this complication, Dolan et al. (5) used a thin ventilation catheter to support tracheobronchial stent insertion for three patients with tracheobronchial stenosis. Before stent insertion, the distal tip of the ventilation catheter was placed across the stenosis for ventilation, and then the stent insertion was performed under the protection of ventilation. However, there is no similar technique used for placement of Y-shaped airway stent. In this study, we reported our initial clinical experience of subcarinal ventilation-assisted Y-shaped stent insertion under local anesthesia for seven patients with lower tracheal-carinal-main bronchial complex stenosis.     

Ultrastructural studies of the neurovascular unit reveal enhanced endothelial transcytosis in hyperglycemia-enhanced hemorrhagic transformation after stroke

AimsPre‐existing hyperglycemia (HG) aggravates the breakdown of blood–brain barrier (BBB) and increases the risk of hemorrhagic transformation (HT) after acute ischemic stroke in both animal models and patients. To date, HG‐induced ultrastructural changes of brain microvascular endothelial cells (BMECs) and the mechanisms underlying HG‐enhanced HT after ischemic stroke are poorly understood.MethodsWe used a mouse model of mild brain ischemia/reperfusion to investigate HG‐induced ultrastructural changes of BMECs that contribute to the impairment of BBB integrity after stroke. Adult male mice received systemic glucose administration 15 min before middle cerebral artery occlusion (MCAO) for 20 min. Ultrastructural characteristics of BMECs were evaluated using two‐dimensional and three‐dimensional electron microscopy and quantitatively analyzed.ResultsMice with acute HG had exacerbated BBB disruption and larger brain infarcts compared to mice with normoglycemia (NG) after MCAO and 4 h of reperfusion, as assessed by brain extravasation of the Evans blue dye and microtubule‐associated protein 2 immunostaining. Electron microscopy further revealed that HG mice had more endothelial vesicles in the striatal neurovascular unit than NG mice, which may account for their deterioration of BBB impairment. In contrast with enhanced endothelial transcytosis, paracellular tight junction ultrastructure was not disrupted after this mild ischemia/reperfusion insult or altered upon HG. Consistent with the observed increase of endothelial vesicles, transcytosis‐related proteins caveolin‐1, clathrin, and hypoxia‐inducible factor (HIF)‐1α were upregulated by HG after MCAO and reperfusion.ConclusionOur study provides solid structural evidence to understand the role of endothelial transcytosis in HG‐elicited BBB hyperpermeability. Enhanced transcytosis occurs prior to the physical breakdown of BMECs and is a promising therapeutic target to preserve BBB integrity.     

The impact of serum magnesium and calcium on the risk of epilepsy: A mendelian randomization study

Aims

To investigate the causal role of serum magnesium and calcium in epilepsy or any of its subtypes through Mendelian randomization (MR) approach.

Methods

Single nucleotide polymorphisms (SNPs) associated with serum magnesium and calcium were used as the instrumental variables. MR analyses were performed using the summary-level data for epilepsy extracted from International League Against Epilepsy Consortium (15,212 cases and 29,677 controls) to obtain the causal estimates. The analyses were replicated using FinnGen data (7224 epilepsy cases and 208,845 controls), and a meta-analysis was then conducted.

Results

The result of combined analyses showed that higher serum magnesium concentrations was associated with a reduced risk of overall epilepsy (odds ratios [OR] = 0.28, 95% confidence interval [CI], 0.12–0.62, p = 0.002). In ILAE, higher serum magnesium was suggestively associated with reduced risks of focal epilepsy (OR = 0.25, 95% CI 0.10–0.62, p = 0.003). However, the results cannot be repeated in sensitivity analyses. As for serum calcium, the results did not reach statistical significance with overall epilepsy (OR = 0.60, 95% CI, 0.31–1.17, p = 0.134). However, genetically predicted serum calcium concentrations showed an inverse association with risk of generalized epilepsy (OR = 0.35, 95% CI, 0.17–0.74, p = 0.006).

Conclusion

The current MR analysis did not support a causal relationship between serum magnesium and epilepsy, but showed a causally negative association between genetically determined serum calcium and generalized epilepsy.     

神经梅毒发病的危险因素及预测因素研究进展

神经梅毒是梅毒螺旋体侵犯神经系统而导致的较严重的临床阶段,伴或不伴HIV感染的梅毒患者发生神经梅毒的危险因素及预测因素有所不同。HIV阴性梅毒患者发生神经梅毒的危险因素主要包括性别、年龄、梅毒感染阶段、治疗情况等;预测因素包括血清学滴度、脑脊液一些指标的变化及是否伴有神经系统或眼科症状等。HIV病毒载量及CD4 ...     

青斑样血管病64例皮损特点分析

【摘要】 目的 分析青斑样血管病网状青斑和紫癜性皮损的特点、分布规律。方法 回顾中国医学科学院皮肤病医院2017年7月至2020年10月诊治的64例青斑样血管病患者的临床资料。结果 64例中男23例,女41例;年龄13 ~ 54岁,发病年龄7 ~ 51岁,48例25岁前发病;病程6个月至10年。49例夏季发病或病情加重,皮损基本表现为坏死性不规则紫癜、紫癜性皮病样红斑、不规则溃疡、网状青斑、毛细血管扩张、不规则的白色萎缩性瘢痕和色素沉着。64例溃疡和坏死性紫癜多为不规则形,发生于足背和踝关节周围。40例有紫癜性皮病样的皮损表现,其中32例表现为色素性紫癜,8例表现为毛细血管扩张性紫癜。4例出现麻木刺痛等神经末梢受损的症状。结论 青斑样血管病的皮损表现多样,对于出现广泛网状青斑、紫癜样皮病样皮损、麻木等症状的患者,需做好鉴别诊断。     

生长抑素及其类似物联合质子泵抑制剂应用于急性非静脉曲张性上消化道出血的循证分析

目的 系统评价生长抑素及其类似物联合质子泵抑制剂（proton pump inhibitor，PPI）治疗急性非静脉曲张性上消化道出血（acute non-variceal upper gastrointestinal bleeding，ANVUGIB）的有效性和安全性，并分析其用药经济性。方法 采用循证医学方法搜集生长抑素及其类似物联合PPI治疗ANVUGIB的RCT、队列研究进行meta分析，得到相应的有效性及安全性分析结果，并进行成本-效果分析。结果 最终纳入6个RCT均未接受内镜治疗，共610例受试者。Meta分析结果显示，生长抑素及其类似物联合高、中、低剂量PPI治疗在以下方面均优于单用高、中、低剂量PPI治疗，差异有统计学意义，总有效率[OR=3.34，95%CI（2.03，5.47），P<0.000 01]、止血时间[MD=-9.04，95%CI（-11.69，-6.38），P<0.000 01]、输血量[MD=-1.10，95%CI（-1.46，-0.74），P<0.000 01]；在不良反应发生率方面，2组差异无统计学意义[OR=0.49，95%CI（0.11，2.12），P=0.34]。ANVUGIB患者予生长抑素联合高、中、低剂量奥美拉唑与单用高、中、低剂量奥美拉唑进行成本-效果分析，增量成本效果比分别为172.28，217.26，330.37，敏感性分析后显示结果稳定。而接受内镜治疗后应用生长抑素及其类似物联合PPI治疗仅1个队列研究，研究结果显示内镜治疗成功后联合治疗并不优于PPI单药治疗。结论 现有证据表明，生长抑素及其类似物联合PPI治疗未经内镜治疗的ANVUGIB患者为较有效的方案，两者安全性相当、耐受性较好，从药品直接成本考虑，高剂量PPI组联合治疗较中、低剂量PPI组联合治疗更具有成本效果性。而对于经内镜下止血治疗的患者两者疗效相当，可考虑单用PPI。     

POEMS综合征8例临床分析

目的探讨POEMS综合征发病机制及临床特征，提高对POEMS综合征的诊治水平。方法分析8例POEMS综舍征的一般资料、临床表现、相关的辅助检查、治疗及预后，并结舍文献进行讨论。结果本病是累及多系统的疾病，以周围神经病最具有特征性，肝、脾和（或）淋巴结肿大，内分泌的病变，皮肤改变，水肿及骨髓浆细胞增多比较常见。治疗以激素、免疫抑制剂为主，可结合抗雌激素、放疗的方法，预后差。结论POEMS综合征与浆细胞病关系密切，累及多系统的病变，临床表现复杂多样，应注意多系统的检查，提高临床的诊断水平。     

急性脑卒中患者血清神经元特异性烯醇化酶、S-100B蛋白、髓鞘碱性蛋白水平的变化

目的探讨急性脑卒中患者血清神经元特异性烯醇化酶(NSE)、S-100B蛋白、髓鞘碱性蛋白(MBP)水平变化及其临床意义。方法回顾性对照分析发病在48 h内的45例急性脑卒中患者(其中脑梗死组19例,脑出血组15例,短暂性脑缺血发作组11例)血清NSE、S-100B蛋白、MBP水平变化及其与脑梗死、脑出血患者神经功能缺损程度的相关性。结果脑梗死组和脑出血组患者血清NSE、S-100B蛋白、MBP水平均较对照组有不同程度增高(P<0.05),而短暂性脑缺血发作组与正常对照组比较均无明显变化。脑梗死组和脑出血组患者中神经功能缺损较重的中重型亚组患者血清NSE、S-100B蛋白、MBP水平较轻型亚组水平高(P<0.05)。结论血清NSE、S-100B蛋白、MBP水平可作为急性脑卒中患者病情判断、预后评估的指标之一,对早期脑梗死与短暂性脑缺血发作也有鉴别诊断价值,尤其适用于无法进行影像学检查的脑卒中患者。